Lethal Means Assessment among Emergency Department Patients

In an emergency department that screens all patients for suicide risk, providers rarely document that they have performed an access to lethal means assessment with suicidal patients. 

Using patient charts from August 2014 through December 2015 at an urban emergency department, researchers identified 800 patients in three age groups who screened positive for suicide risk. Overall, only 18 percent of patients with a positive screen had documentation of a lethal means assessment by at least one provider. Among those, only 8 percent had documentation that a provider discussed an action plan to reduce access. Patients were more likely to have a documented lethal means assessment if they had a chief complaint involving psychiatric behavior, a previous emergency department visit for substance use or psychiatric issues, and current suicidal ideation.

Lethal means counseling and its documentation are a component of recommended care for all patients who screen positive for suicide risk. Adding standardized templates to patient charts could help prompt providers to assess for lethal means and document the outcome of that discussion.

Betz, M. E., Kautzman, M., Segal, D. L., Miller, I., Camargo, C. A., Boudreaux, E. D., & Arias, S. A. (2018). Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Research, 260, 30–35.

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