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“No abnormality detected”: A mixed-methods examination of Emergency Department coding practices for people in suicidal crisis

McCarthy, M, Saini, P, Nathan, R, Ashworth, E and McIntyre, J (2024) “No abnormality detected”: A mixed-methods examination of Emergency Department coding practices for people in suicidal crisis. Archives of Suicide Research. pp. 1-14. ISSN 1381-1118

No Abnormality Detected A Mixed-Methods Examination of Emergency Department Coding Practices for People in Suicidal Crisis.pdf - Published Version
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Background: Accurate identification of suicidal crisis presentations to emergency departments (EDs) can lead to timely mental health support, improve patient experience, and support evaluations of suicide prevention initiatives. Poor coding practices within EDs are preventing appropriate patient care. Aims of the study are (1) examine the current suicide-related coding practices, (2) identify the factors that contribute to staff decision-making and patients receiving the incorrect code or no code. Method: A mixed-methods study was conducted. Quantitative data were collated from six EDs across Merseyside and Cheshire, United Kingdom from 2019 to 2021. Attendances were analyzed if they had a presenting complaint, chief complaint, or primary diagnosis code related to suicidal crisis, suicidal ideation, self-harm or suicide attempt. Semi-structured interviews were conducted with staff holding various ED positions (n = 23). Results: A total of 15,411 suicidal crisis and self-harm presentations were analyzed. Of these, 21.8% were coded as ‘depressive disorder’ and 3.8% as ‘anxiety disorder’. Absence of an appropriate suicidal crisis code resulted in staff coding presentations as ‘no abnormality detected’ (23.6%) or leaving the code blank (18.4%). The use of other physical injury codes such as ‘wound forearm’, ‘head injury’ were common. Qualitative analyses elucidated potential causes of inappropriate coding, such as resource constraints and problems with the recording process. Conclusion: People attending EDs in suicidal crisis were not given a code that represented the chief presentation. Improved ED coding practices related to suicidal crisis could result in considerable benefits for patients and more effective targeting of resources and interventions.

Item Type: Article
Uncontrolled Keywords: Coding practices; emergency departments; suicidal crisis; 1701 Psychology
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Divisions: Psychology (from Sep 2019)
Publisher: Taylor and Francis Group
SWORD Depositor: A Symplectic
Date Deposited: 09 May 2024 09:12
Last Modified: 09 May 2024 09:12
DOI or ID number: 10.1080/13811118.2024.2337195
URI: https://researchonline.ljmu.ac.uk/id/eprint/23206
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