Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders

被引：17

作者：

Bowden, Cadence F. ^{[1
]}

True, Gala ^{[2
,3
]}

Cullen, Sara Wiesel ^{[4
]}

Pollock, Miranda ^{[2
]}

Worsley, Diana ^{[1
]}

Ross, Abigail M. ^{[5
]}

Caterino, Jeffrey ^{[6
]}

Olfson, Mark ^{[7
]}

Marcus, Steven C. ^{[4
,8
,9
]}

Doupnik, Stephanie K. ^{[1
,8
,10
]}

机构：

[1] Childrens Hosp Philadelphia, Ctr Pediat Clin Effectiveness, Div Gen Pediat, PolicyLab, Philadelphia, PA 19104 USA

[2] Louisiana State Univ, Hlth Sci Ctr, New Orleans Sch Med, New Orleans, LA USA

[3] Southeast Louisiana Vet Hlth Care Syst, New Orleans, LA USA

[4] Univ Penn, Sch Social Policy & Practice, Philadelphia, PA 19104 USA

[5] Fordham Univ, Grad Sch Social Serv, New York, NY 10023 USA

[6] Ohio State Univ, Dept Emergency Med, Columbus, OH 43210 USA

[7] Columbia Univ, Dept Psychiat, New York, NY USA

[8] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA

[9] Univ Penn, Ctr Mental Hlth, Philadelphia, PA 19104 USA

[10] Univ Penn, Dept Pediat, Philadelphia, PA 19104 USA

来源：

ANNALS OF EMERGENCY MEDICINE | 2021年 / 78卷 / 05期

关键词：

NATIONAL TRENDS; UNITED-STATES; OLDER-ADULTS; VISITS; PATTERNS; CHILDREN; CARE;

D O I：

10.1016/j.annemergmed.2021.04.025

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. Methods: We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. Results: Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. Conclusion: Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces. Please see page 629 for the Editor's Capsule Summary of this article. Copyright (C) 2021 by the American College of Emergency Physicians.

引用

页码：628 / 636

页数：9