J Korean Soc Emerg Med.  2016 Feb;27(1):75-81. 10.0000/jksem.2016.27.1.75.

Characteristics of Suicidal Attempters with Acute Poisoning Who Discharged Against Psychiatric Medical Advice and Emergency Department Admission as an Acute Intervention

• Lim YG
• Jeong HH
• Park EJ
• Min YG
• Choi SC

• KMID: 2191640
• DOI: http://doi.org/10.0000/jksem.2016.27.1.75

Abstract

PURPOSE
Discharge against medical advice (DAMA) carries a risk of increased mortality and readmissions in the emergency department (ED). The aim of the current study was to examine characteristics of suicidal attempters with acute poisoning who were discharged against psychiatric medical advice and other clinical department admission as acute intervention.
METHODS
We retrospectively selected a consecutive series of suicidal attempters with acute poisoning who were admitted to the emergency department between 2011 and 2012. Sex, age, admission time, psychiatric DAMA, impressions by the Psychiatrist-in-charge, and psychiatry follow-up after discharge were reviewed in the medical records. DAMA was defined as an unplanned discharge for which the psychiatrist-in-charge documented in the medical record that the patient or one's legally authorized representatives decided to refuse hospitalization against the psychiatrist's medical advice including closed ward admission.
RESULTS
A total of 883 patients who had attempted suicide who visited the emergency department were included. Of these, 155 patients were suicidal attempters with acute poisoning for ED ward admission. Among these patients, the rate of psychiatric DAMA was 66.5% (n=103). Psychiatric impressions were 1) adjustment disorder 51.5% (n=53), 2) major depressive disorder 28.2% (29%). The rate of DAMA was higher in the adjustment disorder group than in the major depressive disorder group (82.8% vs 58.7%, p <0.001). The rate of follow-up after hospital discharge to the psychiatric outpatient department was 26.5% (n=27).
CONCLUSION
Admission to the emergency department may improve psychiatric outpatient department referral in suicidal attempters with acute poisoning. In addition, customized plans according to psychiatric diagnosis will be considered for effective acute intervention and continuous psychiatric referral.

Keyword

Suicide; Poisoning; Treatment refusal; Patient discharge

MeSH Terms

Adjustment Disorders
Depressive Disorder, Major
Emergencies*
Emergency Service, Hospital*
Follow-Up Studies
Hospitalization
Humans
Medical Records
Mental Disorders
Mortality
Outpatients
Patient Discharge
Poisoning*
Referral and Consultation
Retrospective Studies
Suicide
Suicide, Attempted
Treatment Refusal