McCarthy, M (2024) Emergency Department Coding Practices and Staff Decision-Making for People Attending in Suicidal Crisis: A Mixed-Methods Study. Doctoral thesis, Liverpool John Moores University.

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Abstract

This thesis aimed to make a critical contribution to research and practice relating to Emergency Department (ED) coding practices and staff decision-making for people attending in suicidal crisis. Gaps in the literature include a primary focus on self-harm as the outcome, failing to account for suicidal crisis presentations when physical treatment needs were not present, limited search strategies to identify presentations from ED records when exploring presentations and auditing records, and a lack of exploration of decision-making from the perspective of different staff along the clinical pathway. To address these identified gaps in the literature, five unique studies were developed, adopting a range of methods and analyses.

First, cross-sectional data were analysed from a large community-based public health survey in the North West Coast, England (N=3,412) to explore the predictors of self-harm and ED-related attendance. Self-harm was the primary outcome of this study due to the absence of appropriately collected and recorded data for suicidal crisis. Second, a systematic review of 17 papers examined the factors influencing ED staff decision-making. To help understand the findings, 23 semi-structured interviews were subsequently conducted with a range of ED staff; the qualitative data were then combined with quantitative data extracted from 15,411 suicide-related ED presentations across six EDs in Cheshire and Merseyside, to allow for a mixed-methods exploration of staff decision-making. Finally, call data were examined for 4,979 mental health crisis lines to explore the newly implemented service to divert people away from attending EDs during the COVID-19 pandemic.

Overall, the thesis highlighted challenges and inconsistencies in the field and provided suggestions for how best to record suicidal crisis within EDs. The need for specific coding guidelines and training to support staff was also discussed, taking into account the significant pressures ED staff face. Findings also provided a better understanding of the factors influencing staff decisions along the clinical pathway, highlighting similar challenges and concerns at all levels (staff burnout, negative ED culture, increased working pressures and environmental concerns). Finally, gaps in ED staff’s confidence and knowledge were discussed in relation to negative attitudes and language, and how this can negatively impact on a patient’s presentation, experience, and care.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Suicide; Coding Practices; Decision-Making
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
SWORD Depositor:	A Symplectic
Date Deposited:	02 May 2024 10:52
Last Modified:	02 May 2024 10:54
DOI or ID number:	10.24377/LJMU.t.00022942
Supervisors:	Saini, P, McIntyre, JC, Nathan, R and Ashworth, E
URI:	https://researchonline.ljmu.ac.uk/id/eprint/22942

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