Objective Given the public health importance of suicide-related behaviors and the corresponding gap in the performance measurement literature, we sought to identify key candidate process indicators (quality of care measures) and structural measures (organizational resources and attributes) important for emergency department (ED) management of pediatric suicide-related behaviors. Methods We reviewed nationally endorsed guidelines and published research to establish an inventory of measures. Next, we surveyed expert pediatric ED clinicians to assess the level of agreement on the relevance (to patient care) and variability (across hospitals) of 42 candidate process indicators and whether 10 hospital and regional structural measures might impact these processes. Results Twenty-three clinicians from 14 pediatric tertiary-care hospitals responded (93% of hospitals contacted). Candidate process indicators identified as both most relevant to patient care (≥87% agreed or strongly agreed) and most variable across hospitals (≥78% agreed or strongly agreed) were wait time for medical assessment; referral to crisis intervention worker/program; mental health, psychosocial, or risk assessment requested; any inpatient admission; psychiatric inpatient admission; postdischarge treatment plan; wait time for first follow-up appointment; follow-up obtained; and type of follow-up obtained. Key hospital and regional structural measures (≥87% agreed or strongly agreed) were specialist staffing and type of specialist staffing in or available to the ED; regional policies, protocols, or procedures; and inpatient psychiatric services. Conclusions This study highlighted candidate performance measures for the ED management of pediatric suicide-related behaviors. The 9 candidate process indicators (covering triage, assessment, admission, discharge, and follow-up) and 4 hospital and regional structural measures merit further development.
1. A muscle pedicle permitted to remain attached to autogenous bone grafts in rabbits was effective in retaining viability of the contiguous bone. 2. The deeper areas of pedicled bone grafts, remote from the muscle pedicles, did not remain viable. 3. Fractures through the experimental bone grafts with muscle pedicles showed evidence of reparative osteogenesis in the region of the viable bone. 4. Control experiments without muscle pedicles revealed necrosis of the bone grafts. 5. Fractures of the control bone grafts showed no evidence of reparative osteogenesis.
Journal Article An uncommon initial presentation of a common disease Get access Seth Marks, MD, MSc, Seth Marks, MD, MSc Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba Correspondence: Seth Marks, University of Manitoba/Children’s Hospital HSC Winnipeg – Pediatrics, FE307 685 William Ave, Winnipeg, Manitoba R3E0Z2. Telephone 204-787-7435, fax 204-787-1655, E-mail smarks@hsc.mb.ca Search for other works by this author on: Oxford Academic Google Scholar Shane Silver, MD, Shane Silver, MD Department of Medicine, University of Manitoba, Winnipeg, Manitoba Search for other works by this author on: Oxford Academic Google Scholar Norman Silver, MD Norman Silver, MD Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba Search for other works by this author on: Oxford Academic Google Scholar Paediatrics & Child Health, Volume 25, Issue 2, March 2020, Pages 67–68, https://doi.org/10.1093/pch/pxz071 Published: 06 June 2019 Article history Received: 22 March 2019 Accepted: 04 May 2019 Published: 06 June 2019
