How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder
evidence and practice    

How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder

Michael Brian Haslam Lecturer in nurse education, Faculty of Health and Social Care, Edge Hill University, Lancashire, England

Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients’ feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group.

This article expands on Harden’s concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.

Emergency Nurse. doi: 10.7748/en.2019.e1930

Peer review

This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

Correspondence

mbhaslam@gmail.com

Conflict of interest

None declared

Haslam M (2019) How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder. Emergency Nurse. doi: 10.7748/en.2019.e1930

Published online: 28 May 2019