Background: Accurate identification of suicidal crisis presentations to emergency departments (EDs) can lead to timely mental health support, improve patient experience, and support evaluations of suicide prevention initiatives. Poor coding practices within EDs are preventing appropriate patient care. Aims of the study are (1) examine the current suicide-related coding practices, (2) identify the factors that contribute to staff decision-making and patients receiving the incorrect code or no code.
Method: A mixed-methods study was conducted. Quantitative data were collated from six EDs across Merseyside and Cheshire, United Kingdom from 2019 to 2021. Attendances were analysed if they had a presenting complaint, chief complaint, or primary diagnosis code related to suicidal crisis, suicidal ideation, self-harm or suicide attempt. Semi-structured interviews were conducted with staff holding various ED positions (n = 23).
Results: A total of 15,411 suicidal crisis and self-harm presentations were analysed. Of these, 21.8% were coded as ‘depressive disorder’ and 3.8% as ‘anxiety disorder’. Absence of an appropriate suicidal crisis code resulted in staff coding presentations as ‘no abnormality detected’ (23.6%) or leaving the code blank (18.4%). The use of other physical injury codes such as ‘wound forearm’, ‘head injury’ were common. Qualitative analyses elucidated potential causes of inappropriate coding, such as resource constraints and problems with the recording process.
Conclusion: People attending EDs in suicidal crisis were not given a code that represented the chief presentation. The current study provides novel insights into current suicidal crisis coding practices across multiple UK EDs and is the first study to examine why patient coding is inaccurate and variable. Currently, there is no evidence-based clinical guidelines for suicidal crisis ED presentations, as there are for self-harm. It is important to prioritise training and education for all healthcare professionals to improve confidence and knowledge of not only suicidal crisis care, but also how to record such presentations on hospital systems. By implementing a standardised code for suicidal crisis within EDs, NHS coding systems and data recording can be improved, leading to better accuracy, decision-making, research, and resource allocation.