Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm

Abstract

BackgroundSelf-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services.We aimed to investigate (i) if a dataset of ED presentations could be produced using a combination of routinely collected clinical and administrative data and (ii) to validate this dataset against another one produced using methods similar to those used in previous studies.MethodsUsing the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared.ResultsThere were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 % and 76 % of all attendances respectively and both detected 82 % of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records.ConclusionsIt was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed.

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

“… McAlearney, et al [ 36 ] - Consistent communication Communication - Productivity loss during implementation Productivity loss - Small sample size greatly reduces statistical power and external validy. - Careful planning Productivity/ efficiency - Resistance to change Resistance to change - System failure Productivity loss - Poor computer skills Limited staff support - Slow queries Productivity loss Polling, et al [ 37 ] - Data collection Data management - Missing data Missing data / data error - Not all data in the set could be matched with a record due to anonymity requirements. This limited the ability to compare data between records, and therefore limited the number of data points that were analyzed.…”

“…Articles that mentioned both facilitators are marked in the tables with an asterisk. Facilitators identified are productivity/efficiency [19,21,22,24,25,27,28,30*,32,33–36*,38,43,45–47*,51,53-56,59*,60,63,64,70,72,73] ,quality [19*,20,22,24-27,33,34,45,46,49,53,54,56,62,69,72] ,data management [ 7 , 18 – 21 , 26 , 30 , 33 , 37 – 39 , 41 , 48 , 54 , 64 – 66 , 68 , 71 ] , surveillance [19,20,23,25,26,28,31,41,54,55,62,63,66,67,69*,70] , preventative care [19*,23,26,28,30,36,37,39,52,62,63,65,68,69] , communication [ 30 , 36 , 47 , 50 , 58 , 62 , 64 , 70 ] , interoperability [ 7 , 19 , 23 , 31 , 41 , 43 , 47 , 49 ] , decision support [ 7 , 19 , 34 , 56 – 58 , 61 ] , health outcomes [ 25 , 26 , 44 , 53 , 58 , 61 ] , satisfaction [ 32 , 33 , 43 , 57 , 70 ] , financial assistance [ 23 , 47 , 48 , 58 , 66 ] , ease of use [ 20 , 51 , 63 ] , and current technology [ 30 , 47 ] , B...…”

Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics

“…Future work might explore linking HES ED data to clinical records in order to improve case ascertainment. 30 …”

The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder

“…We used a free-text search for records of suicidal ideation (SI) and self-harm during the first index pregnancy occurring in the study cohort. Self-harm was defined as a suicide attempt or self-injurious behaviour, including cutting, burning, hitting, hanging, overdosing, poisoning and electrocuting using terms validated in another CRIS study on self-harm and Emergency Department attendances (Polling et al 2015 ). Complete notes on the self-harm event were scanned for further information on the method of self-harm, triggers (reported hallucinations around 24 h of the event, alcohol and substance use within 12 h of the event) and location (whether event occurred on an inpatient ward or at home and whether the patient was under intensive Home Treatment).…”