Improving Suicide Risk Screening and Detection in the Emergency Department

Abstract

Introduction The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED). Methods A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014. Results Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ2 [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ2 [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview. Conclusions Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.

A Computerized Sexual Health Survey Improves Testing for Sexually Transmitted Infection in a Pediatric Emergency Department

“…This may be in part due to the fact that the ED is not traditionally viewed as a venue for public health interventions and prevention. However, the notion that the ED may serve as a safety net for vulnerable populations has recently gained attention, and screening for high risk conditions such as HIV, 43 intimate partner violence, 44 and suicidality, 45 has started to become more widely practiced. 46 Both existing research and expert consensus support the need for research addressing the effectiveness, sustainability, and integration of ED-based STI screening programs.…”

A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research

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Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk

“…There is a stigma – both societal and to the self – that can lessen individuals’ comfort with disclosure and the sharing of mental health concerns (Ben-Zeev, Young, & Corrigan, 2010; Pattyn, Verhaeghe, Sercu, & Bracke, 2014). Finally, recent studies indicate that suicide risk screening is feasible in these settings and leads to the identification of individuals at risk for suicide who would not otherwise have been identified (e.g., Boudreaux et al, 2016; King, O’Mara, Hayward, & Cunningham, 2009). …”