Objective

To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization.

Methods

Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions.

Results

Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07–2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24–0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28–0.83).

Conclusions

This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.

中文翻译：

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因自杀意念和自残而住院的青少年的护理质量

客观的

检查儿科住院患者自杀意念/自残护理的质量测量表现，以及表现是否与再利用相关。

方法

对 2014 年 9 月 1 日至 2016 年 8 月 31 日期间因自杀意念/自残住院的 8 家医院患者 [N = 1090] 进行回顾性观察研究。评估了两项基于医疗记录的评估自杀意念/自残护理的质量措施，一项是关于限制使用致命手段的咨询护理人员，另一项是关于住院患者和门诊服务提供者之间关于后续计划的沟通。多变量逻辑回归评估了质量测量得分与 1) 医院地点、2) 患者人口统计数据和 3) 30 天急诊科回访和住院患者再入院之间的关联。

结果

医疗记录文件显示，根据医院地点的不同，17% 至 98% 的护理人员接受了致命手段限制咨询（平均 70%）；0% 至 51% 的病例（平均 16%）记录了住院患者与门诊患者提供者的沟通。与男性患者的护理人员相比，女性患者的护理人员记录接受致命手段限制咨询的几率更高（调整后的比值比 [aOR] 1.51，95% 置信区间 [CI]，1.07–2.14）。与白人患者相比，黑人患者记录住院患者与门诊患者提供者随访计划沟通的几率较低（aOR 0.45，95% CI，0.24-0.84）。对于有记录的护理人员接受过致命手段限制咨询的患者，全因 30 天再入院率较低（aOR 0.48，95% CI，0.28-0.83）。

结论

这项研究揭示了有自杀意念/自残的青少年所接受的护理质量的差异和缺陷。为护理人员提供致命意味着出院前的限制咨询可能有助于防止再次入院。