Utilisation of an Integrated Care Pathway for Self-harm in James Cook University Hospital, Middlesbrough. 

Aims: The Integrated Care Pathway for Self-harm (ICP) is a protocol developed collaboratively by Teeswide Liaison Psychiatry Service and South Tees NHS Foundation Trust, UK using guidance from the Royal College of Psychiatrists and National Institute for Health and Care Excellence (NICE) for the short term management of people who present with self-harm at the said acute hospital. This audit aimed to assess adherence to the pathway by determining the proportion of patients presenting with self-harm who were managed according to the protocol and also the proportion of patients presenting with self-harm who received a psychosocial assessment on presentation.      Method: This audit was carried out using a retrospective case note review of 50 self-harm presentations in July 2013. Results: Adherence to ICP was 92%. 92% of presentations also received a psychosocial assessment on presentation. Considering the reasons for non-placement on ICP on admission: 2% of the total sample were directly admitted to Intensive Care Unit from Accident & Emergency; 2% were admitted directly to the Acute Admissions Unit (AAU) due to overcrowding in Accident & Emergency; In 2% of cases the ICP was not utilised with no clear justification; 2% of patients were reported as having “accidental overdose” Considering the reasons for non-receipt of psychosocial assessment on presentation: 2% of the total sample self-discharged; 4% were under police custody on admission and were due to be reviewed by the Criminal Justice Liaison Team of the Mental Health Trust; 2% were described as accidental overdose with no self-harm intent. Comments/ Conclusion: The utilisation of the ICP has enabled the delivery of good quality of service for persons presenting with self-harm to James Cook University Hospital. Through its use, commissioned services can demonstrate that recommended standard of care is being delivered. This is an example of a successful, multidisciplinary, multiagency collaboration. Bibliography Kripalani M, Nag S, Nag S, Gash A. Integrated care pathway for self-harm: our way forward. Emergency Medicine Journal. 2010;27(7):544-6.