Detection of patients at risk for suicide nearly doubled after emergency departments implemented universal suicide risk screenings for all patients, according to new research in the April issue of the American Journal of Preventive Medicine.
The study was conducted by UMass Medical School researchers who trained nurses at eight hospitals in seven states to screen patients for suicide risk factors. Nurses screened patients based on three factors:
- Depressive symptoms
- Active suicidal ideation
- Prior suicide attempts
Patients who either confirmed active suicidal ideation or reported a suicide attempt within the six months prior to visiting the ED were flagged as a positive screening.
Conducted over a five-year period, suicide risk screenings in participating hospitals increased from 26 to 84 percent. Suicide risk identification nearly doubled after universal screenings were implemented.
Before universal screenings, suicide risks were identified 2.9 percent of the time. After universal screenings started, 5.7 percent of suicide risks were identified. In all, more than 235,000 patients were screened.
"Our study is the first to demonstrate that suicide risk screening can be done in a busy ED during routine care," said lead author Edwin Boudreaux, Ph.D. "The public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide."
Patients identified as "at risk for suicide" received additional evaluation and invention resources they may not have otherwise received, said Boudreaux, who is a professor of emergency medicine, psychiatry and quantitative health sciences and serves as vice chair of research for the Department of Emergency Medicine at UMass.
"In fact, with screening we identified a subset of patients whose suicidality was serious enough to warrant psychiatric inpatient treatment. What would have happened to them if they had been discharged? The conventional wisdom is that at least some of those individuals would have tried to kill themselves."
Most patients with positive screens were discharged with a listing of community-based psychological services, a self-help safety plan and a wallet card with local suicide prevention hotline numbers. Among patients with positive screens, some agreed to participate in further study following their ED visit. These patients received a series of structured telephone calls with trained nurses following discharge.
"At a minimum, patients received some resources that could help them on an outpatient basis, which they wouldn't have received if we hadn't detected risk," Boudreaux said.
The study is a part of the ED-SAFE initiative, a project funded by the National Institute of Mental Health. ED-SAFE's goal is to develop evidence-based practice guidelines to optimize EDs as places where suicidal patients are identified. This was the first phase of the project. Next, the the sustainability of the suicide screening and any necessary ED interventions will be refined. Results of the last two phases of the study are forthcoming.
"Our next effort is to apply the suicide detection and prevention work we're doing in the ED to the entire health care system, including primary care and inpatient and outpatient settings," Boudreaux said.
