Acute Psychiatric Hospital Research Articles

Who Determines to Discharge against Medical Advice from an Acute Psychiatric Hospitalization

Subjective: To reduce the nonessential healthcare expenditure and to prevent patients from adverse consequences, we intended in this study to find the prevalence and characteristics of patients with psychiatric disorder with against medical advice (AMA) discharge. Methods: We did a review of medical records for patients who hospitalized on the acute psychiatric ward at Keelung Chang Gung Memorial Hospital in Taiwan from January 1, 2013, to August 31, 2018. Results: We found that 100 patients (8.1%) were discharged AMA out of total 1,237 discharges. Compared to patients with regular discharges, those with AMA discharge were significantly different between the groups in age (p < 0.05), first time admission (p < 0.001), comorbid substance use disorders (p < 0.05), previous suicide attempts (p < 0.01), and length of hospital stay (p < 0.001). With forward stepwise logistic regression model to look for the most influential predictors for AMA discharge, we found that odds ratio (95% confidence interval) of those with suicidal attempt history (1.931 [1.265–2.949], B = 0.658, p < 0.01) and those with the first-time psychiatric admission (3.435 [2.253–5.237], B = 1.234, p < 0.001) significantly predicted those AMA patients. Conclusion: The history of suicide attempt and first-time psychiatric ward admission is the most important predictors for patients with AMA discharge. We suggest that controlled prospective studies can strengthen the study findings and better describe the impact on patients with AMA discharge.

Factitious disorder comorbid with borderline personality disorder and dysthymia: from medically unexplained physical symptoms to functional neurological disorder.

In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes. The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records. The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations. Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.

Supportive Transition Planning for Adolescents Transitioning From Psychiatric Hospitalization to School: A Systematic Literature Review and Framework of Practices.

School-aged youth with behavioral health needs often struggle in the academic environment. When admitted to acute psychiatric hospital settings, the student's difficulties and needs increase upon discharge and return to the school setting. While the literature describes systemic issues in transitioning from an acute psychiatric hospital to the school setting, limited resources exist for practitioners to plan for and support the successful reintegration of affected students. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the purpose of the current systematic review was to collect and synthesize evidence from the literature (N = 20) in the areas of barriers, challenges, and significance of the need for a formal transition planning framework. Four major key factors emerged as important to assist in creating a transition planning framework for acute psychiatric hospitals to school-based settings: (a) Stakeholder Voice (Student, Caregiver, Hospital/Treatment Team, or School Team Voice); (b) Establishing a Point Person for Transition (Medical or School Point Person); (c) Recommendations/Accommodations (Formal or Informal Supports); and (d) Having a Transition Meeting. Other common factors are discussed, and recommendations are provided to aid practitioners in increasing the likelihood that school-age youth succeed in the school environment post-discharge from acute psychiatric settings. Finally, gaps in the literature are identified as areas for further research.

The Wilkie's Syndrome which Disguised As Anorexia Nervosa: A Case Report

Abstract Wilkie's Syndrome (WS), Superior Mesenteric Artery Syndrome or aortomesenteric clamp is an infrequent cause of high intestinal obstruction that is produced by an angular constriction (< 25º) between the superior mesenteric artery and abdominal aorta, resulting in a compression of the third duodenal portion. Its incidence is estimated around 0.013-0.3% in general population, as it is more common in women between 10-39-years. This pathology produces unspecific gastrointestinal symptoms, turning diagnostic suspicion really important, due to its critical complications. The case of a 15-year old woman is presented, who is admitted in an acute child psychiatric hospitalisation unit because she displays eating disorder symptomatology in the previous months. Initially she is suspected for suffering Anorexia Nervosa (AN) but according to the rapid general deterioration that she suffers the case is profoundly studied and eventually diagnosed as a Wilkie's Syndrome case, based on an exhaustive complementary test battery. This case shows the importance of the diagnostic suspicion of this entity and the relevance of making a proper differential diagnosis in Eating Disorders (ED).

Factors associated with patient readmission to a specialised psychiatric hospital in the Eastern Cape.

Hospital readmissions increase healthcare system costs and can place additional strain on already sparse government funds and under-resourced hospitals. Few studies have investigated readmission of patients in mental health facilities in South Africa. The study aimed to identify the factors associated with readmission of patients discharged from an acute psychiatric public hospital in South Africa. The study was conducted at an acute psychiatric public hospital. A retrospective review of medical records was conducted for all patients admitted and readmitted between January 2018 and December 2019. From the pool of patient records analysed (n = 516), 93 (18.02%) were readmitted, of which the majority (75.27%) were male. The average age of patients readmitted was 27.24 ± 11.16 years, which was significantly younger than the total sample (p < 0.05; CI 1.095-7.105). Findings indicated that patients who completed lower levels of education, were unemployed and were diagnosed with substance (mono- or polysubstance) use disorder (n = 93; 100%), schizophrenia (n = 33; 35.48%), bipolar disorder (n = 9; 9.68%) or intellectual disability (n = 9; 9.68%) were more frequently readmitted, with the average length of stay varying widely between patients. Younger patients and those living with more complex psychiatric conditions, particularly those who are substance abusers, were readmitted more frequently, indicating that these patients may require special consideration for management. The study revealed that patients living with complex psychiatric conditions such as schizophrenia and bipolar disorder were readmitted to hospital more frequently, indicating that management of these patients at the community level is challenging.

Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services.

This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic. Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.

Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

BackgroundPre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff.ObjectivesTo identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care.MethodsTo shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021.ResultsThe chi-square test for multiple response sets revealed consistently significant differences (p < 0.001) between EM and PS with respect to the questions analyzed. Approximately 36% of EM reported not to be adequately qualified to handle psychiatric emergencies (p = 0.0001), while around 50% of respondents were neutral in their assessment in how to deal with psychiatric emergencies. 80% of EM reported a negative interaction (rejection of patients) with PS when referring a psychiatric emergency patient to the acute psychiatric unit. The most common reasons for refusal were intoxication (EM: 78.8%, PS: 88.2%), emergency physician therapy (EM: 53.8%, PS: 63.5%), and not resident in the catchment area of the hospital (EM 68.8%, PS: 48.2%). In the casuistry presented, most respondents would choose “talk down” for de-escalation (EM: 92.1%, PS: 91.3%). With respect to drug therapy, benzodiazepine is the drug of choice (EM: 70.4%, PS: 78.8%). More EM would choose an intravenously (i.v.) or a Mucosal Atomization Device (MAD) administration as an alternative to oral medication (i.v.: EM: 38.8%, PS: 3.8%, p = 0.001, MAD: EM: 36.7%, PS: 10.6%, p = 0.006). Significantly more EM would seek phone contact with the acute psychiatric hospital (EM: 84.7%, PS: 52.9%, p = 0.0107). A psychiatric emergency plan was considered useful in this context by more than 90% of respondents. The need for further training for EM with regard to treating psychiatric clinical syndromes was considered important by all respondents. In particular, the topics of “psychogenic seizure,“ “intoxication,“ and “legal aspects of psychiatric emergencies” were considered important (Mann-Whitney U test, p < 0.001).ConclusionThe interaction-related problems identified in the emergency medical care of pre-clinical psychiatric patients relate to non-modifiable, structural problems, such as insufficient admission capacity and non-existent or inadequate monitoring capabilities in acute psychiatric hospitals. However, factors such as the education and training of EM and communication between EM and PS can be improved. Developing personalized emergency care plans for psychiatric patients could help to optimize their care.

39.4 After Care From the Clinic: Staff Support, Telepsychiatry, and Professional Development

Youth discharged from the acute inpatient setting are at high risk for readmission and potential self-injury. Additionally, many youth fail to establish care with outpatient community mental health care providers due to barriers to access. School-based staff are often left to navigate after-care from acute psychiatric hospitalization with limited training and support. Patients and families are sometimes resistant to school-based interventions out of concerns for privacy. Hospitals, schools, and communities have begun to come together to address this complex problem.

2.92 Internet-Related Problems Contributing to Acute Psychiatric Crises and Hospitalizations Among Children and Adolescents Before and After the Onset of the COVID-19 Pandemic

The role of internet-related problems in psychiatric crises has not been widely studied. We examine characteristics of internet-related crises resulting in psychiatric admission. We hypothesized that internet-related problems would increase after the onset of the COVID-19 pandemic, when youth access to the internet increased from online schooling.

Antinuclear Antibodies and Thyroid Autoantibodies in the Serum of Chinese Patients with Acute Psychiatric Disorders: A Retrospective Study.

It has been shown that autoimmune diseases are associated with psychiatric disorders in epidemiological studies. The acute psychiatric disorder patients have higher frequency of autoantibodies in the blood, including antinuclear antibodies, anti-thyroid peroxidase, and thyroglobulin [thyroid antibody carriers]. However, large clinical studies with more relevant control groups in China are few. This was a retrospective study. A total of 1669 sera were tested for autoantibodies in the clinical laboratory of the Fourth Affiliated Hospital, Zhejiang University School of Medicine from October 2016 to March 2021. All data available during this time period were analyzed. Only the first entry for each patient from inpatient care units was used for analysis. The clinical information and laboratory data of patients were retrospectively collected and analyzed. A significantly lower prevalence of antinuclear antibodies was observed in the healthy control group than in the patient group (21.7% vs 28.8%, P < .05). There was a significant difference in the prevalence of antinuclear antibodies between thyroglobulin-antibody carriers and thyroid peroxidase-antibody- and thyroglobulin-antibody-seronegative individuals in the unipolar depressive disorder group (P < .05). A positive anti-thyroid peroxidase test was significantly associated with patients having nonaffective psychoses (P < .05). The results showed that psychiatric disorders were associated with antinuclear antibodies and thyroid autoantibodies in our large sample of patients admitted to acute psychiatric hospitalization, and autoimmune autoantibodies were potential biomarkers of psychotic disorders. The results might lead to new research directions for the study of psychiatric disorders in the future.

Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates.

Background: Appropriate and adequate treatment of psychiatric conditions in the community or at first presentation to the hospital may prevent rehospitalization. Information about hospital readmission factors may help to reduce readmission rates. This scoping review sought to examine the readmission of patients to acute psychiatric hospitals to determine predictors and interventions to reduce psychiatric readmission rates. Method: A scoping review was conducted in eleven bibliographic databases to identify the relevant peer-reviewed studies. Two reviewers independently assessed full-text articles, and a screening process was undertaken to identify studies for inclusion in the review. PRISMA checklist was adopted, and with the Covidence software, 75 articles were eligible for review. Data extraction was conducted, collated, summarized, and findings reported. Result: 75 articles were analyzed. The review shows that learning disabilities, developmental delays, alcohol, drug, and substance abuse, were crucial factors that increased the risk of readmission. Greater access to mental health services in residential treatment and improved crisis intervention in congregate care settings were indicated as factors that reduce the risk of readmission. Conclusion: High rates of readmission may adversely impact healthcare spending. This study suggests a need for focused health policies to address readmission factors and improve community-based care.

Humanization of care in acute psychiatric hospitalization units: A scoping review.

INTRODUCTION: Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. The present study can help to improve the care offered in acute mental health units.

Psychoeducational group satisfaction in an acute psychiatric hospital

ABSTRACT Acute psychiatric hospitals assist individuals in need of immediate crisis interventions. This exploratory study evaluates current psychoeducational group therapy in an acute psychiatric hospital. Patients were surveyed on satisfaction immediately after attending psychoeducational groups. Topics of the therapy groups included safety planning, coping with stress, positive self-talk, relapse prevention, spirituality, and creative expression. Results showed that overall, patients were highly satisfied with the psychoeducational groups offered with the spiritual group having the highest overall rating. Data from patients’ surveys revealed changes to be made that would improve group satisfaction. Further research on internal variables influencing satisfaction on psychoeducational groups is suggested by the researcher.

Short-term aerobic exercise for depression in acute geriatric psychiatry: study protocol for a randomized controlled trial

BackgroundMajor depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms.MethodsA single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients’ depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes.DiscussionThis short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians.Trial registrationGerman Clinical Trial Register ID: DRKS00026117Trial statusProtocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.

Pharmacist-led medication reconciliation on admission to an acute psychiatric hospital unit.

Background:Therapy management in patients suffering from mental health disorders is complex and the risks derived from changes or interruptions of treatment should not be ignored. Medication reconciliation in psychiatry may reduce medication errors and promote patient safety during transitions of care.Objective:To identify the influence of complementary information sources in the construction of the best possible medication history, and to ascertain the potential clinical impact of discrepancies identified in a medication reconciliation service.Methods:An observational study was conducted in an acute mental hospital unit, with a further validation in an internal medicine unit. Adult patients taking at least one medicine admitted in the unit were included. Patients/caregivers were interviewed upon admission and the information gathered was compared with hospital medical and shared electronic medical records. Once the best possible medication history was gathered, therapeutic information was reconciled against the prescription on admission to identify discrepancies. Potential clinical impact of medication errors was classified using the International Safety Classification.Results:During the study period, 148 patients were admitted, 50.7% females, mean age 54.6 years (SD=16.3). Collaboration of a caregiver was a needed in 74% of the interviews. In total, 1,147 drugs were considered to obtain patients’ best possible medication history. After reconciliation, 560 clinically sound intentional discrepancies were identified and 359 discrepancies required further clarification from prescribers: 84.12% “drug omission”, 5.57% “drug substitution”, 6.96% “dose change”, and 3.34% “dosage frequency change”. Potential clinical impact of these medication discrepancies was classified as: 95 mild, 100 moderate, and 29 severe medication errors.Conclusion:About 1 in three intentional discrepancies observed in a pharmacists-led medication reconciliation service required further clarification from prescribers, being 80% of them unintentional discrepancies. Results highlight the importance of the caregiver as source of information for the psychiatric patient, the relevance of analyzing shared electronic health records until 6 months before, and the need to use hospital medical records efficiently. Additionally, 29 discrepancies were classified as errors with potentially severe clinical impact. A medication reconciliation service is concluded to be feasible and necessary in a mental health unit.

Overcoming Challenges and Achieving Higher Recovery in Coordination with Nurses Employed in Psychiatric Wards

Psychiatric nurses oversee the day-to-day operational activities of a psychiatric hospital. Positivity is one of the essential qualities of a psychiatric nurse. Nurses require emotional strength to cope with disrespectful patients who refuse medication or deny having a mental condition. In acute psychiatric institutions, depression and bipolar disorder are common diagnoses and treatments. Ten psychiatric nurses and ten nutritionists from public and private hospitals in and around Kolkata, West Bengal, participated in this qualitative study that relied on a purposeful sampling method. Telephonic interviews were scheduled based on responses to semi-structured surveys. Before beginning the discussions, informed consent was obtained. Only those who volunteered were deemed to be mentally at ease and keen to talk about their experiences. The coding analysis was performed using the Atlas ti-9 software, and the participants' opinions were tallied using networking, word cloud, and other methods. Results of participants’ perceptions show that mental health nurses have several responsibilities; one of the most important is maintaining a positive attitude. Most patients committed to acute psychiatric hospitals suffer from major depressive disorder, anxiety, or bipolar disorder. Despite a lack of research, some foods have been hypothesized to aid mental health. As a result, mental health facilities' nurses and dietitians encounter constant, unprecedented difficulties in their work. Besides, psychiatrists, nurses, and nutritionists face some of the most challenging patients in the hospital when working in mental wards. Overall, nurses and nutritionists need thorough training in dealing with adverse circumstances if their patients are to make full recoveries and enjoy their work.

Documentation, Application and Efforts to Reduce Involuntary Admissions and Coercive Measures - Results from a Nationwide Study on Acute Psychiatric Hospitals in Germany

This nationwide full census survey investigated the documentation status regarding involuntary admissions and coercive measures in psychiatric hospitals in Germany. As part of the ZIPHER study, a questionnaire survey on the documentation, application and reduction of coercion was conducted (N = 147, response rate = 34.4 %). The majority of participating hospitals reported a comprehensive documentation of the use of coercion. However, substantial regional differences could be found in this regard as well as for the use of guidelines. The involuntary admission quote was M = 13.4 % (± 10.9). Of those, 33.9 % (± 22.2) were affected by mechanical restraint, 8.9 % (± 17.2) by seclusion, and 11.8 % (± 18.0) by compulsory medication. The regional differences plead for a unification of legal bases and applied practice as well as for a merge of respective data on a nationwide level of the relevant stakeholders.

The Soteria model: implementing an alternative to acute psychiatric hospitalization in Israel

ABSTRACT Background Since 2016, Soteria homes have been operating in Israel. In this report we describe the implementation of the model. Methods Data for 486 residents staying in one of three Soteria homes from 2016 through 2020 are presented. The model, and necessary modifications, are discussed. Results The majority of the residents in the Soteria homes suffered from psychotic (41.3%) or bipolar disorder (20.9%) and were of a mean age of 34.5 (SD = 12.83). While operating according to the principles of Soteria, adaptations had to be made. The homes used professional staff as well as companions. Accepting a wide range of residents exposed the home to situations of violent behaviour which required adjustment in admission policy. Work with insurers limited the possible length of stay. Financial constraints expanded the home capacity to 10 residents, while limiting work shifts to 12 hours. Cultural considerations led to the establishment of single-gender homes. Discussion Soteria homes can be a viable component of publicly-funded mental health care systems. The implementation of the Soteria model can provide important lessons for the future development of a professional and humane mental health care service – not as an alternative, but as an integral part of the system.

Associations of short-term exposure to air pollution and increased ambient temperature with psychiatric hospital admissions in older adults in the USA: a case–crossover study

SummaryBackgroundLittle is known about the associations between ambient environmental exposures and the risk of acute episodes of psychiatric disorders. We aimed to estimate the link between short-term exposure to atmospheric pollutants, temperature, and acute psychiatric hospital admissions in adults aged 65 years and older in the USA.MethodsFor this study, we included all people (aged ≥65 years) enrolled in the Medicare programme in the USA who had an emergency or urgent hospital admission for a psychiatric disorder recorded between Jan 31, 2000, and Dec 31, 2016. We applied a case-crossover design to study the associations between short-term exposure to air pollution (fine particulate matter [PM2·5], ozone, and nitrogen dioxide [NO2]), ambient temperature, and the risk of acute hospital admissions for depression, schizophrenia, and bipolar disorder in this population. The percentage change in the risk of hospital admission and annual absolute risk differences were estimated.FindingsFor each 5°C increase in short-term exposure to cold season temperature, the relative risk of acute hospital admission increased by 3·66% (95% CI 3·06–4·26) for depression, by 3·03% (2·04–4·02) for schizophrenia, and by 3·52% (2·38–4·68) for bipolar disorder in the US Medicare population. Increased short-term exposure to PM2·5 and NO2 was also associated with a significant increase in the risk of acute hospital admissions for psychiatric disorders. Each 5 μg/m3 increase in PM2·5 was associated with an increase in hospital admission rates of 0·62% (95% CI 0·23–1·02) for depression, 0·77% (0·11–1·44) for schizophrenia, and 1·19% (0·49–1·90) for bipolar disorder; each 5 parts per billion (ppb) increase in NO2, meanwhile, was linked to an increase in hospital admission rates of 0·35% (95% CI 0·03–0·66) for depression and 0·64% (0·20–1·08) for schizophrenia. No such associations were found with warm season temperature.InterpretationIn the US Medicare population, short-term exposure to elevated concentrations of PM2·5 and NO2 and cold season ambient temperature were significantly associated with an increased risk of hospital admissions for psychiatric disorders. Considering the increasing burden of psychiatric disorders in the US population, these findings suggest that intervening on air pollution and ambient temperature levels through stricter environmental regulations or climate mitigation could help ease the psychiatric health-care burden.

A rapid review of emergency department interventions for children and young people presenting with suicidal ideation.

Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.