Research| Volume 45, ISSUE 6, P661-669, November 2019

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If You Could Change 1 Thing to Improve the Quality of Emergency Care for Deliberate Self-harm Patients, What Would It Be? A National Survey of Nursing Leadership

Published:September 05, 2019DOI:



      Emergency departments increasingly treat patients for deliberate self-harm. This study sought to understand emergency department nursing leadership perspectives on how to improve the quality of emergency care for these patients.


      ED nursing managers and directors from a national sample of 476 hospitals responded to an open-ended question asking for the 1 thing they would change to improve the quality of care for self-harm patients who present in their emergency departments. We identified and coded key themes for improving the emergency management of these patients, then examined the distribution of these themes and differences by hospital characteristics, including urbanicity, patient volume, and teaching status.


      Five themes regarding how to improve care for deliberate self-harm patients were identified: greater access to hospital mental health staff or treatment (26.4%); better access to community-based services and resources (26.4%); more inpatient psychiatric beds readily accessible (20.9%); separate safe spaces in the emergency department (18.6%); and dedicated staff coverage (7.8%). Endorsement of findings did not differ based on hospital characteristics.


      ED nursing leadership strongly endorsed the need for greater access to both hospital- and community-based mental health treatment resources for deliberate self-harm patients. Additional ED staff and training, along with greater continuity among systems of care in the community, would further improve the quality of emergency care for these patients. Broad policies that address the scarcity of mental health services should also be considered to provide comprehensive care for this high-risk patient population.

      Key words

      Emergency department management of self-harm; Mental health care; Emergency nursing care
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      Sara Wiesel Cullen is a researcher at the School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA.


      Amaya Diana is a research assistant at the Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA.


      Mark Olfson is Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law and Professor of Epidemiology at Columbia University, and a research psychiatrist at New York State Psychiatric Institute, New York, NY.


      Steven C. Marcus is a Research Associate Professor at the School of Social Policy & Practice, University of Pennsylvania, Philadelphia PA.