Standard Operating Procedures

    Available information in hospital records on cases of self-harm and suicide attempts is limited and sometimes incomplete. Achieving standardization and uniformity within and across countries will contribute to improved accuracy and comparability of data on hospital referred suicide attempts globally.

    Standard operating procedures should be developed in each country in line with the local or regional context to provide guidance on data collection, case ascertainment, data items and analysis processes for the surveillance system.


    Data Collection

    Where possible, each data collector will work within a number of hospitals (public and private). The data collector should work within the national guidelines of data protection and should sign a confidentiality agreement on appointment by the surveillance management team.

    If a data collector is external, the following steps should be taken before a first visit to a hospital:

    • Hospital management should meet representatives of the surveillance management team and should be fully informed about the surveillance system.
    • Formal written permission for data collection should be obtained from the hospital’s chief executive officer or manager.
    • Relevant emergency department staff and medical records officers should be informed of the surveillance system.

    The first visit to a hospital should be by appointment. Ideally, the hospital chief executive officer will personally introduce the data collector to relevant hospital staff (e.g. emergency department, medical records personnel). Visits to hospitals must be made regularly – weekly, fortnightly or monthly according to the number of attendances at the emergency department involving suicide attempts. It is useful to have contact with a member of staff who is regularly on duty (e.g. an administrative officer). In larger hospitals where weekly visits are needed, attempt to arrange a regular time slot.

    Procedures for data collectors:

    • Make a courtesy telephone call prior to visiting a hospital for data collection
    • Make themselves known to hospital staff at each visit. Identification as surveillance system data collectors and/or authorization issued by the hospital must be carried at all times
    • Strictly observe arrangements for security and confidentiality within the hospital. Medical records should never be taken from assigned areas without the specific permission/knowledge of hospital staff.
    • Be aware of the current situation in an emergency department and be prepared to leave if necessary.
    • Keep all written material pertaining to the surveillance system in their possession
    • Personal details of cases should not be discussed.
    • Any requests for information must be referred to the office of the national or regional surveillance system.
    • Any material not relevant to the surveillance system should be ignored.
    • Details of identifiable patients should never be discussed over the telephone.
    • Conduct themselves in a professional manner and use appropriate language.


    Case Ascertainment

    While most hospital presentations will occur through the emergency department, systems should be put into place to check records of all presentations to the hospital, i.e. medical records, casualty book or hospital computer file. If permission to access the computer system is not granted, a printout must be sought that gives details of all presentations. If the hospital will provide such a printout only for specific types of emergency department presentations, it is important that the categories are broad enough to include as close to 100% of all intentional self-harm presentations as possible.

    If there is evidence (e.g. a note written in the medical records) that a patient did not want his/her data to be passed to an agency outside of the hospital, the patient’s wish must be respected. In such a case, no information on this patient should be recorded by the data collector.


    Data Items

    Core data items and as many of the optional items as possible should be included in the registration form of the surveillance system.

    Core Data Items:

    • Data collector (name or identification number of designated person collecting data)
    • Date of registration
    • Hospital number (a number should be assigned to each hospital when the surveillance system is being set up)
    • Unique event number (each event of self-harm should be given a unique number)
    • Unique person identification number (each person should be given a unique identification number)
    • Sex
    • Date of birth
    • Age
    • Postal/area code
    • Date of presentation
    • Time of presentation
    • Mode of arrival at the hospital
    • Seen by on arrival at the hospital
    • Date of the self-harm
    • Day of the week of the self-harm
    • Time of the self-harm

    Optional Data Items:

    • Nationality
    • Country of origin
    • Ethnicity
    • Religion
    • Marital status
    • Employment status
    • Socioeconomic status
    • Sexual orientation
    • Living circumstances / type of accommodation
    • Referral
    • Follow-up
    • Previous admissions to hospital for self-harm
    • Mental disorder / psychiatric history
    • Alcohol or drug use
    • Chronic pain and/or physical illness
    • History of treatment for physical or mental health problems
    • Acute emotional distress (e.g. break-up in relationship, family discord or loss, job loss, financial difficulties, housing problems, legal problems, problems at school or at work, intimate partner violence, experience of crime, trauma or abuse, being bullied, experiencing discrimination)
    • Suicide or suicide attempt in the family
    • Suicide or suicide attempt among friends, school-mates or work colleagues
    • Knowledge of suicide or suicide attempt from the Internet or other media