Background
Self-harm is an increasing challenge in healthcare. Every year, thousands of patients are admitted to Danish emergency departments due to self-harming behavior. These patients often have complex needs requiring both physical treatment and psychiatric support. Unfortunately, the emergency system is not organized to handle this complexity, which can lead to fragmented care and an increased risk of repeated self-harm.

To strengthen care for patients who self-harm, the Joint Emergency Department at Odense University Hospital and Psychiatry in the Region of Southern Denmark established a collaborative project in 2022. The project is structured in three phases.

Phase 1: Mapping patient pathways (2023)
In the first phase, 20 patient pathways were analyzed through observations and interviews. The results revealed:

1. High expectations of patients’ ability to cooperate in the emergency department despite their mental health challenges.
2. Insufficient competencies among healthcare professionals to address psychiatric needs.
3. Unclear distribution of responsibilities and limited communication between the emergency department, psychiatry, and other actors.

These factors led to chaotic patient pathways, with many patients not receiving necessary support after discharge. The findings formed the basis for phase 2, in which the research group involved patients, relatives, and healthcare professionals from psychiatry and the emergency department. The aim was to collaboratively identify potential solutions to improve current practice.

Phase 2: Development of solutions (2024)
Based on the problems identified in phase 1, two concepts were developed through workshops with patients, relatives, and healthcare professionals:

1. Joint position between psychiatry and the emergency department: Two nurses share their time between the two departments to improve communication, treatment plans, and follow-up. This ensures that patients are assessed by psychiatric competencies from arrival in the emergency department and are offered follow-up after discharge.
2. Psychiatric on-call function: A psychiatric nurse can be summoned from psychiatry to the emergency department when patients with self-harm are admitted. This function operates around the clock to assess the patient’s mental state and create a care plan. Follow-up is not included in this function.

These solutions aim to ensure more coherent care and better patient experiences and outcomes.

Future steps in Phase 3 (2025–2026)
The two concepts are now being tested in clinical practice to evaluate their impact on patient pathways and intersectoral collaboration. Experiences from these tests will form the basis for potential wider implementation.

Phase 3: Testing two concepts for improved care of patients who self-harm

Concept 1: Joint position between emergency department and psychiatry (2025)
Two nurses work across the somatic and psychiatric emergency departments with a 50/50 time split. Their tasks include:

• Suicide risk assessment and crisis planning for patients admitted with self-harm.
• Follow-up conversations the day after discharge to ensure continuity and support.
• Educational tasks to strengthen staff competencies in psychiatric care.

The goal is to ensure all patients receive a treatment plan and follow-up, and that staff are better equipped to handle psychiatric issues.

Concept 2: Psychiatric on-call function (2026)
This concept strengthens psychiatric presence in the emergency department around the clock by summoning a psychiatric nurse when a patient is admitted with self-harm. The nurse performs:

• Suicide risk assessment and recommendations for further care.
• Coordination with partners such as residential facilities and local psychiatry.

The nurse’s role concludes once a plan for the patient’s ongoing care is established.

Evaluation and outcome measures

• Primary outcomes: Has a treatment plan been established and followed up?
• Secondary outcomes: Number of readmissions due to self-harm within 7 and 30 days.
• Feasibility: Recruitment, acceptability, and practical applicability are assessed through qualitative interviews with patients, relatives, and staff.

The two concepts are tested over six months to examine their effects on patient pathways, staff experiences, and organizational factors. The results will inform future improvements.

Perspectives
Ultimately, the project aims to ensure that patients and their relatives experience a marked improvement in care pathways, with clearer allocation of responsibilities among involved parties, contributing to more coherent and effective treatment.