Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

Eve Griffin; Sheena M McHugh; Anne Jeffers; David Gunnell; Ella Arensman; Ivan J Perry; Grace Cully; Brendan McElroy; Margaret Maxwell; Shu-Sen Chang; Eimear Ruane-McAteer; Paul Corcoran

doi:10.1136/bmjopen-2021-055962

Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

BMJ Open. 2021 Dec 24;11(12):e055962. doi: 10.1136/bmjopen-2021-055962.

Authors

Eve Griffin^{1

2}, Sheena M McHugh³, Anne Jeffers⁴, David Gunnell^{5

6}, Ella Arensman^{3

2}, Ivan J Perry³, Grace Cully^{3

2}, Brendan McElroy⁷, Margaret Maxwell⁸, Shu-Sen Chang⁹, Eimear Ruane-McAteer^{3

2}, Paul Corcoran²

Affiliations

¹ School of Public Health, University College Cork, Cork, Ireland evegriffin@ucc.ie.
² National Suicide Research Foundation, Cork, Ireland.
³ School of Public Health, University College Cork, Cork, Ireland.
⁴ Health Service Executive, Dublin, Ireland.
⁵ NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁶ Population Health Sciences, University of Bristol, Bristol, UK.
⁷ Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
⁸ Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK.
⁹ Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City, Taiwan.

Abstract

Background: A National Clinical Programme for the Management of Hospital-Presenting Self-Harm (NCP-SH) was introduced in Ireland in 2014. This involved the development of a model of care to standardise the management of self-harm in emergency departments, to be delivered by dedicated clinical nurse specialists. The core components of the programme were to: ensure an empathic and timely response, conduct a biopsychosocial assessment, involve family members in assessment and discharge planning, and provide a bridge to next care. The overall aim of the programme was to reduce the rate of repeat self-harm. This multistage study will evaluate the impact of the NCP-SH on hospital-presenting self-harm and to identify determinants influencing its implementation.

Methods: Employing a sequential mixed methods design, the first stage will use data from the National Self-Harm Registry Ireland to examine the impact of the NCP-SH on self-harm repetition, along with other aspects of care, including provision of psychosocial assessments and changes in admissions and postdischarge referrals. A cost-effectiveness analysis will assess the cost per repeat self-harm attendance avoided as a result of the NCP-SH. The second stage will identify the influences of implementation fidelity-adherence to the programme's core components-using a combination of document analysis and semistructured interviews with staff of the programme, guided by the Consolidated Framework for Implementation Research.

Ethics and dissemination: This study has received full ethical approval and will run until August 2023. This study is novel in that it will identify important factors influencing successful implementation of complex programmes. It is expected that the findings will provide important learnings for the integration of mental health services in general hospital settings and will be disseminated via peer-review publications along with reports for clinicians and policy-makers.

Keywords: accident & emergency medicine; health economics; health services administration & management; organisation of health services; quality in health care; suicide & self-harm.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare*
Emergency Service, Hospital
Hospitals, General
Humans
Patient Discharge
Self-Injurious Behavior* / psychology
Self-Injurious Behavior* / therapy