Suicide Screening in Emergency Departments
March 29, 2012
A study by investigators affiliated with the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) project found that emergency departments (EDs) are failing to conduct suicide screenings for many patients who exhibit characteristics associated with a high risk of suicide (such as psychiatric complaints or a history of substance abuse). The research also revealed that many patients who screen positive for suicidal ideation or behavior are not provided with appropriate follow-up care.
Analysis of the records of 800 patients who presented in EDs of eight participating hospitals revealed that while “the presence of known psychiatric problems and substance use had the strongest associations with suicide screening, even patients presenting with these indicators were not screened for suicide.” Only 39 (5 percent) of these 800 patients were screened for suicide risk. The authors of an article reporting these findings expressed disappointment about the lack of appropriate screening as well as the inadequate response to the 23 patients who screened positive for suicidal behavior or ideation. Only 36 percent of these patients were evaluated by a mental health professional. Eight percent were given a formal safety plan, 23 percent were admitted to a medical ward for observation, and 5 percent were admitted to a psychiatric ward. Yet 90 percent of the 23 patients who screened positive for suicidal behavior or ideation had presented at the ED because of psychiatric complaints (including depression). Eight percent had gone to the ED because of self-harm. One-third of these patients admitted abusing alcohol or drugs, both of which are risk factors for suicide.
The authors suggest that their research confirms the “need for improved suicide screening practices to ensure appropriate treatment for those at risk for suicide” as recommended by National Patient Safety Goal 15A (Patient Suicide) of the Joint Commission on Accreditation of Healthcare Organizations.
Ting, S. A., Sullivan, A. F., Millar, I., Espinola, J. A., Allen, M. H., Camargo, C. A., & Boudraux, E. D. (2012). Multicenter study of predictors of suicide screening in emergency departments. Academic Emergency Medicine, 19, 239-243.
For more information on National Patient Safety Goal 15A (Patient Suicide) see A Resource Guide for Implementing the Joint Commission 2007 Patient Safety Goals on Suicide