title: Developing measures of quality for the emergency department management of pediatric suicide-related behaviors.
abstract: 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.
authors.affiliation: Keenan Research Centre, St Michael'sHospital, Toronto, Ontario,Canada. rhodesa@smh.ca
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bethell
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Jesmin
authors.initials: J
authors.lastname: Antony
authors.forename: Lil
authors.initials: L
authors.lastname: Tonmyr
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.forename: David
authors.initials: D
authors.lastname: Chaulk
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
authors.forename: Serge
authors.initials: S
authors.lastname: Gouin
authors.forename: Gary I
authors.initials: GI
authors.lastname: Joubert
authors.forename: Robert
authors.initials: R
authors.lastname: Porter
authors.forename: Norman
authors.initials: N
authors.lastname: Silver
authors.forename: Jennifer
authors.initials: J
authors.lastname: Spruyt
authors.forename: Graham Cameron
authors.initials: GC
authors.lastname: Thompson
authors.forename: Troy W S
authors.initials: TW
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D008297:Male; D011787:Quality of Health Care / Q000592:standards*; D059020:Suicidal Ideation; D055815:Young Adult