Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm

Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses ( ) were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, . The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, ). 1. Introduction 1.1. Background The National Institute of Excellence in Britain defines self-harm as “intentional self-poisoning or injury, irrespective of the apparent purpose of the act.” The incidence in Ireland of deliberate self-harm has increased dramatically. In the four-year period since 2007, there has been a 27% increase in the incidence of deliberate self-harm cases in men and a 17% increase in women presenting to Irish emergency departments [1]. Furthermore, in 2011 alone, there were 12,216 cases of deliberate self-harm presentations to Irish emergency departments [1]. Deliberate self-harm is the single most important risk factor for suicide [2, 3]. A mortality follow-up study of 11,586 patients in the United Kingdom found that the risk of suicide in the first year following an act of deliberate self-harm was 0.7%, which was 66 times the annual risk of suicide in the general population [3]. Furthermore, a recent study found that physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population [4]. Triage in Irish emergency departments is conducted using the Manchester Triage Scale. This focuses on medical and surgical presentations but fails to provide guidance on the triage of patients with psychiatric presentations. This is despite the fact that up to 5% of people attending the emergency departments present with primary psychiatric problems