Process mapping and quantitative analyses for the development of a self-harm and violence emergency care registry: The SAVER project
1
Bangor University, Bangor, United Kingdom
2
Betsi Cadwaldr University Health Board, North Wales, United Kingdom
3
Swansea University, Swansea, United Kingdom
4
University of Manchester, Manchester, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A2571
ABSTRACT
INTRODUCTION:
Injury prevention strategies depend on timely, reliable surveillance data that can inform both upstream prevention and service-level interventions. Self-harm and interpersonal violence (IPV) share common risk factors and frequently present to emergency departments (EDs), yet are often monitored through fragmented systems. In Wales, existing ED surveillance for violence is limited in scope, and no self-harm registry exists. The SAVER programme was established to address this gap.
METHODS:
We conducted detailed process mapping across EDs and minor injury units (MIUs) within a regional health system to characterise patient pathways, decision points, and data capture processes for self-harm and violence-related injuries. We undertook quantitative analyses of routinely collected electronic health record data.
RESULTS:
Process mapping demonstrated that a single electronic platform captured all ED and MIU attendances, enabling comprehensive case identification. However, substantial variation was observed in how injury intent, risk, and onward referrals were recorded across sites and pathways. Quantitative analyses identified a high burden of repeat presentations and marked gaps between recommended and observed care. Only approximately one-third of self-harm presentations received a psychosocial assessment despite a 100% target, and a significant proportion of patients referred onward from MIUs for violence-related injuries did not attend ED follow-up. Data completeness and consistency varied by injury type, indicating risks of misclassification and missed prevention opportunities.
CONCLUSIONS:
Integrating process mapping with quantitative analysis provided critical system intelligence for injury prevention, revealing both structural gaps and actionable targets for intervention. These findings will directly inform the design of a future registry, including priority variables, and real-time reporting that can be used to improve individual patient care. The approach offers a scalable model for embedding injury surveillance within routine emergency care to strengthen prevention, improve pathways, and support policy-relevant decision-making.
Injury prevention strategies depend on timely, reliable surveillance data that can inform both upstream prevention and service-level interventions. Self-harm and interpersonal violence (IPV) share common risk factors and frequently present to emergency departments (EDs), yet are often monitored through fragmented systems. In Wales, existing ED surveillance for violence is limited in scope, and no self-harm registry exists. The SAVER programme was established to address this gap.
METHODS:
We conducted detailed process mapping across EDs and minor injury units (MIUs) within a regional health system to characterise patient pathways, decision points, and data capture processes for self-harm and violence-related injuries. We undertook quantitative analyses of routinely collected electronic health record data.
RESULTS:
Process mapping demonstrated that a single electronic platform captured all ED and MIU attendances, enabling comprehensive case identification. However, substantial variation was observed in how injury intent, risk, and onward referrals were recorded across sites and pathways. Quantitative analyses identified a high burden of repeat presentations and marked gaps between recommended and observed care. Only approximately one-third of self-harm presentations received a psychosocial assessment despite a 100% target, and a significant proportion of patients referred onward from MIUs for violence-related injuries did not attend ED follow-up. Data completeness and consistency varied by injury type, indicating risks of misclassification and missed prevention opportunities.
CONCLUSIONS:
Integrating process mapping with quantitative analysis provided critical system intelligence for injury prevention, revealing both structural gaps and actionable targets for intervention. These findings will directly inform the design of a future registry, including priority variables, and real-time reporting that can be used to improve individual patient care. The approach offers a scalable model for embedding injury surveillance within routine emergency care to strengthen prevention, improve pathways, and support policy-relevant decision-making.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
