Extent of self-harm behaviour presenting to Queensland ED with mental health problems

In 2018, there were 3046 deaths by suicide in Australia. Suicide was the leading cause of death among people age 15-44 in 2016-2018. In Queensland, rates remain highest in young men, particularly in rural areas.

The emergency department (ED) can be the only option for people in a mental health crisis. Presentations with self-harm and attempted suicide are recognised high-risk events for subsequent suicide.

This data-linkage study is the first of its kind in Queensland, examining ED presentations with self-harm between 2012 and 2017, utilising data from a collaboration examining broader mental health presentations. This ED data will be ‘linked’ to inpatient admissions and death records, allowing insight into the patient journey over several years.

Aligning with national and international calls to make suicide and self-harm a priority for research and policy innovation, the study will examine the demographics, co-morbidities and characteristics of these patients, and factors predictive of hospital admission to improve care and recognition around those presenting to ED with self-harm.

Decimalate: Use of an on-line Smart Test and survey to determine whether comprehension of decimals is a barrier to interpretation of clinical chemistry results among Emergency Department staff.

Recognition of the extent of medication errors resulting from misinterpretation of instructions have resulted in a multitude of recommended practices to reduce the likelihood. One area which may contribute to error, but one which has received less attention, is that of accurate interpretation of clinical chemistry results. It is well recognised that numbers containing decimal places can lead to error in medications with decimals overlooked or misplaced. Anecdotal evidence from Emergency Physicians indicates difficulty in interpreting clinical chemistry results which are presented with leading decimals (e.g. 0.0095 g/l).

Misconceptions about decimals have been the subject of extensive study. Half of student teachers were unable to place 0.606, 0.0666, 0.6, 0.66 and 0.060 in correct sequence and 40 per cent of nurses demonstrated a lack of basic computational ability with, and incomplete or incorrect conceptual understanding of, decimals. No research has been found to-date with medical staff. Whilst remedial teaching is beneficial it may not be a practical solution to the identified problem within the Emergency Department. Rather a change in the presentation of results may provide a simple and practical solution; for example the presentation of Troponin 1 as 40 pg/ml rather than 0.04 ng/ml. Such change will not be effected however without evidence of need.

The goal of the research is to provide recommendations which ultimately could lead to improvements in patient safety. The more modest project objectives are to increase user friendliness of results and reduce the potential for errors.