Citation

Rhodes AE, Bethell J, Newton AS, Antony J, Tonmyr L, Bhanji F, Chaulk D, Curtis S, Gouin S, Joubert GI, Porter R, Silver N, Spruyt J, Thompson GC, Turner TW. Pediatr. Emerg. Care 2012; 28(11): 1124-1128.

Affiliation

From the *Suicide Studies Research Unit and the Keenan Research Centre at the Li Ka Shing Knowledge Institute, St Michael's; Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto; The Institute for Clinical Evaluative Sciences; †Suicide Studies Research Unit, St Michael's, Toronto, Ontario; ‡Department of Pediatrics, University of Alberta, Edmonton, Alberta; §The Injury and Child Maltreatment Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario; ∥Divisions of Pediatric Critical Care and Pediatric Emergency Medicine, Department of Pediatrics, and Centre for Medical Education, McGill University, Montreal, Quebec; ¶Alberta Children's Hospital and Department of Pediatrics (Pediatric Emergency Medicine), University of Calgary, Calgary; #Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta; **CHU Sainte-Justine, Montréal, Québec and Division of Emergency Medicine, Department of Pediatrics, Université de Montréal, Montréal, Québec; ††London Health Sciences Centre and Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Western Ontario, London, Ontario; ‡‡Discipline of Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador; §§Winnipeg Children's Hospital and Department of Pediatrics (Pediatric Emergency Medicine), University of Winnipeg, Winnipeg, Manitoba; and ∥∥Alberta Children's Hospital, Calgary, Alberta, Canada.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/PEC.0b013e3182712981

PMID

23114232

Abstract

OBJECTIVE: Given the public health importance of suicide-related behaviors and the corresponding gap in the performance measurement literature, we sought to identify key candidate process indicators (quality of care measures) and structural measures (organizational resources and attributes) important for emergency department (ED) management of pediatric suicide-related behaviors. METHODS: We reviewed nationally endorsed guidelines and published research to establish an inventory of measures. Next, we surveyed expert pediatric ED clinicians to assess the level of agreement on the relevance (to patient care) and variability (across hospitals) of 42 candidate process indicators and whether 10 hospital and regional structural measures might impact these processes. RESULTS: Twenty-three clinicians from 14 pediatric tertiary-care hospitals responded (93% of hospitals contacted). Candidate process indicators identified as both most relevant to patient care (≥87% agreed or strongly agreed) and most variable across hospitals (≥78% agreed or strongly agreed) were wait time for medical assessment; referral to crisis intervention worker/program; mental health, psychosocial, or risk assessment requested; any inpatient admission; psychiatric inpatient admission; postdischarge treatment plan; wait time for first follow-up appointment; follow-up obtained; and type of follow-up obtained. Key hospital and regional structural measures (≥87% agreed or strongly agreed) were specialist staffing and type of specialist staffing in or available to the ED; regional policies, protocols, or procedures; and inpatient psychiatric services. CONCLUSIONS: This study highlighted candidate performance measures for the ED management of pediatric suicide-related behaviors. The 9 candidate process indicators (covering triage, assessment, admission, discharge, and follow-up) and 4 hospital and regional structural measures merit further development.

Language: en