Self-poisoning patients discharged from accident and emergency: risk factors and outcome

In a prospective audit of 1,096 consecutive attendances by deliberate self-poisoning patients at an accident and emergency department (A&E), such patients were discharged directly from A&E on 31% of occasions. Outcome and risk were compared for patients admitted to hospital and discharged directly from A&E. In the following year repetition of self-poisoning occurred in the same proportions of patients admitted to hospital and discharged from A&E (12%, relative risk 1.02). Suicide during the following three years occurred in 1.3% of patients admitted and 1.1% of those discharged (relative risk 1.2). Patients admitted to hospital from A&E were those likely to be at greater risk: they were older, reported more physical ill-health, expressed a threat or left a note more often, and had more frequently experienced psychiatric inpatient care. Thus, nearly one-third of deliberate self-poisoning attenders were discharged from A&E; outcomes were similar despite higher risk among admitted patients, suggesting that brief admission has some benefit.