ABSTRACT

This quality improvement activity examined Safety Planning Intervention (SPI) over two 3-monthly periods for presentations from 13–17-year-olds with suicidal risk to a regional hospital Emergency Department (ED). We collected patient demography, presentation characteristics, presentation rate, and clinician use of SPI, including those under Emergency Examination Authorities (EEAs). An education workshop was offered between the audits, aimed to increase clinician (social work, psychology, nursing, and psychiatry) knowledge of SPIs. The annual ED presentation rate for suicide risk for 15–17-year-olds was 1,520 per 100,000 persons. More presentations were female, non-Indigenous persons, and fewer than half presented voluntarily. Most presentations were for suicide attempt followed by suicide threat. In the first audit clinicians initiated SPIs in fewer than 50% of cases and completed SPIs in 15%. Whereas in the second audit where SPIs were initiated by clinicians in 69% of cases and fully completed in 49%, less than half the presentations with EEAs received a completed SPI. Indigenous persons, although a lower proportion of presentations, were overrepresented for the population. Following the education workshop, there was an improvement in SPI completion, reflecting the benefits of education and training to clinical staff. Lastly, this study highlights the benefit of conducting audits as quality improvement activities for patient care.

IMPLICATIONS

• The international literature indicates an increase in child and youth suicide attempts. This increase requires preparedness from social workers and other clinicians (psychology, nursing, and psychiatry) who offer front-line healthcare for these presentations.

• Safety plans are best-practice and tailored strengths-based plans undertaken between a clinician and client so that the client feels confident knowing where to go and to whom to talk to avoid further suicide attempts.

• Social workers play an important role in undertaking safety plans with clients (especially those who are particularly vulnerable) in hospital and community settings to maximise client outcomes.

摘要

这项质量改进活动检查了安全计划干预 (SPI)，为期 3 个月，期间为 13-17 岁，有自杀风险的儿童向地区医院急诊科 (ED) 的报告。我们收集了患者人口统计学、表现特征、表现率和临床医生对 SPI 的使用情况，包括那些在紧急检查机构 (EEA) 下的情况。在审计之间举办了一次教育研讨会，旨在增加临床医生（社会工作、心理学、护理和精神病学）对 SPI 的了解。15-17 岁青少年自杀风险的年急诊就诊率为每 100,000 人 1,520 人。更多的介绍是女性、非土著人，只有不到一半是自愿参加的。大多数陈述都是针对自杀未遂，然后是自杀威胁。在第一次审计中，临床医生在不到 50% 的病例中启动了 SPI，在 15% 的病例中完成了 SPI。而在第二次审计中，SPI 由临床医生在 69% 的案例中发起，并在 49% 的案例中完全完成，只有不到一半的 EEA 报告获得了完整的 SPI。土著人虽然在演讲中所占比例较低，但在人口中所占比例过高。在教育研讨会之后，SPI 完成情况有所改善，反映了教育和培训对临床工作人员的好处。最后，这项研究强调了将审核作为患者护理质量改进活动的好处。不到一半的 EEA 演示文稿获得了完整的 SPI。土著人虽然在演讲中所占比例较低，但在人口中所占比例过高。在教育研讨会之后，SPI 完成情况有所改善，反映了教育和培训对临床工作人员的好处。最后，这项研究强调了将审核作为患者护理质量改进活动的好处。不到一半的 EEA 演示文稿获得了完整的 SPI。土著人虽然在演讲中所占比例较低，但在人口中所占比例过高。在教育研讨会之后，SPI 完成情况有所改善，反映了教育和培训对临床工作人员的好处。最后，这项研究强调了将审核作为患者护理质量改进活动的好处。

影响

• 国际文献表明，儿童和青少年的自杀企图有所增加。这种增加需要社会工作者和其他临床医生（心理学、护理和精神病学）做好准备，他们为这些报告提供一线医疗保健。

• 安全计划是临床医生和客户之间制定的最佳实践和基于优势的量身定制的计划，以便客户有信心知道去哪里以及与谁交谈以避免进一步的自杀企图。

• 社会工作者在与客户（尤其是那些特别脆弱的客户）在医院和社区环境中制定安全计划以最大限度地提高客户成果方面发挥着重要作用。