Background: People who intentionally self-harm (ISH) are known to attend to emergency departments (ED), with a sub-group re-presenting on multiple occasions.Re-presentations within a short timeframe are poorly understood.The aim of this study was to describe the number, characteristics and management of patients who presented to an emergency department with intentional self-harm; and then re-presented for any reason within one week.Methods: A retrospective records review from one New Zealand emergency department over 12 months in 2006 was undertaken and analysed using descriptive statistics.Excluded were patients who presented more than 12 times.A sample of 48 patients and 73 first and second presentations was identified.Results: Of the 120 patients who attended the emergency department more than once with intentional self-harm, 48 re-presented on 73 occasions within one week.Of the re-presentations, 55% occurred within one day.Mental health assessments by emergency department staff were minimal; challenging behaviours occurred in a quarter of presentations; and challenging behaviours were common with just under half (48%) of presentation pairs exhibiting such behaviour in at least one presentation (see Scenarios).There was no evidence that cultural assessment for patients that identified as Maori (indigenous population of New Zealand) (23%) was provided.Inpatient admission rates increased for second presentations.Conclusion: This small study found that a group of patients re-presented to the emergency department following intentional self-harm within days.Inadequate assessment of these often distressed patients appeared risky and costly.It is suggested that system improvements in the emergency department including collaboration with mental health services could better address the needs of patients who present with intentional self-harm.