Emergency Department Coding Practices for People in Suicidal Crisis.

Background: Emergency departments (EDs) are often the first point of contact for someone experiencing suicidal crisis, yet the recording on hospital electronic records is inconsistent and lacks precision. This can have significant impacts on understanding future risk, improving services and ensuring appropriate support. It is important to make large data, such as electronic health records, useful not only to ensure individual patient presentations receive the appropriate care and follow-up, but also for funding allocations, service planning, and ensuring appropriate resources are allocated to areas with the highest levels of need to reduce health inequalities. This proposal aims to increase the UK evidence base, learn from international research and best practice and co-develop guidance to support staff coding suicidal crisis presentations. Methods: This novel research will address the significant knowledge and practice gaps through: Workstream One : Systematic review To date, no research has systematically reviewed the availability and use of suicide-related codes within emergency departments internationally (Workstream One). This will be done to inform best practice since the majority of research has previously been conducted outside of a UK NHS setting. Findings will also feed into Workstream Four. Workstream Two: Secondary data analysis. WS2 will involve a secondary analysis of a large dataset across 6 EDs in Merseyside and Cheshire, including variables such as demographics, coding information along the pathway and outcome data. To build upon existing analysis, Workstream Two will: (1) examine the number of suicidal crisis presentations based on deprivation index and (2) whether the code received influences the outcome of presentation (i.e., if an individual receives a code of suicide attempt are, they more likely to see a mental health liaison team compared to other suicide-related codes). Workstream Three: Large qualitative study across healthcare and operational professionals. Healthcare and operational staff identified as being involved in an individual's suicidal crisis care pathway and the coding of such presentations will be invited to take part in a qualitative study. The study will explore if a suicidal crisis code was introduced would you: (1) use it, (2) what the presentation would look like for the code to be used, (3) would it be useful in everyday practice, (4) facilitators and barriers to using the code, (5) what type of information or guidance do they need to facilitate suicidal crisis coding. Workstream Four: Co-production of guidance to support suicidal crisis coding. The project PPI group, healthcare staff (doctors, nurses), operational professionals (managers, business intelligence staff), as well as representatives from Public Health England, will be involved in the co-production of guidance, using a realist methodology. The guidance will explore how to code suicidal crisis presentations and include a checklist to facilitate coding. Anticipated Impact and Dissemination: The proposed work aims to have real-world impact through developing coding guidelines for suicidal crisis presentations. Outputs will be disseminated to individual EDs, key stakeholders, policy makers and academic communities through lay summaries, reports, academic peer-reviewed publications and conference presentations. Findings will also be disseminated at policy level through evidence summaries and open calls.