Improve Coding Practices for Patients in Suicidal Crisis

Abstract

Aims

The recording of suicidal ideation in emergency departments (EDs) is inconsistent and lacks precision, which can impede appropriate referral and follow-up. EDs are often the first point of contact for people experiencing suicide-related distress, but while data are available on attendances for self-harm, no comparable data exist for suicidal crisis.

Methods

Data were collected from six EDs across Cheshire and Merseyside (N = 42,096). Data were derived from presenting complaints, chief complaints and diagnosis codes for all suicidal crisis attendances (suicidal ideation, self-harm, suicide attempt) from January 2019 to December 2021.

Results

There was inconsistent coding within and between ED sites for people presenting in suicidal crisis. Attendances for suicidal ideation were often given the chief complaint code of ‘depressive disorder’ (12%). There was a high level of missing data related to the coding of suicide-related presentations (65%). Variation in coding was also reported for individual presentations; for example, 12% of attendances reported to be due to ‘self-inflicted injury’ were given a primary diagnosis code of ‘depressive disorder’ rather than ‘deliberate self-harm’. There was also high variability in the routinely collected data (e.g., demographic information, attendance source and mode, under the influence at time of arrival) both within and between EDs.

Conclusion

Accurate detection and documentation of suicidal crisis is critical to understand future risk and improve services. Research and development in monitoring systems for suicidal crisis should be a priority for health services, and a national data collection tool is urgently needed to maximise accuracy and utility. Better data could be used to inform crisis care policy and to target suicide-prevention resources more effectively.