Knowledge, Attitudes, and Practices of Emergency Department Providers in the Care of Suicidal Patients

Abstract

Background We sought to examine the knowledge, attitudes and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI). Methods 631 providers at eight EDs completed a voluntary, anonymous survey (79% response rate). Results The median participant age was 35 (interquartile range: 30-44) years and 57% were female. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81-91%) than in skills to assess risk severity (64-70%), counsel patients (46-56%) or create safety plans (23-40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6-20%) or that suicidal patient treatment was almost always a top ED priority (15-21%). More nurses (37%, 95%Confidence Interval [CI] 31-42%) than physicians (7%, 95%CI 4-10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self-confidence in skills, (OR 1.60, 95%CI 1.17-2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95%CI 1.11-2.69) and 5+ post-graduate years of clinical experience (OR 2.06, 95%CI 1.03-4.13). Conclusions ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.

Change in Emergency Department Providers’ Beliefs and Practices After Use of New Protocols for Suicidal Patients

“…The Emergency Medicine Network (www.emnet-usa.org) coordinated survey administration, as described previously (14, 21). Survey completion constituted informed consent, and the project was approved by the institutional review board of each participating ED.…”

Coping With Suicidal Thoughts: A Survey of Personal Experience

“…Nevertheless, the more frequent negative ratings for emergency or crisis service settings suggests a reconsideration of how these services might collaborate more with people in crisis. A survey of emergency department providers 10 identified a need for additional training regarding assessment, counseling, and referral for people with suicidal thoughts. Addressing consumers’ negative perceptions of existing emergency services may require additional training for emergency care providers or increased availability of alternative emergency care resources, including respite services and peer-provided services.…”

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

“…Such stakeholders may include ED clinicians, pediatricians, parents, gun owners, and others. Numerous barriers to screening and intervention likely exist, including: time constraints in busy EDs; 46 limited patient receptivity to questions; 47 and lack of knowledge about or training in counseling techniques. 48 Other possible barriers include the potential for unintended consequences of screening and liability issues.…”

“…Issues specific to the realm of suicide include the following: provider attitudes; 46,59,60 relative responsibilities of ED providers and mental health consultants; decision-making capacity regarding firearm storage; role of family members in these discussions; and legislation related to options for temporary firearm transfer or storage. 61 As firearm suicide has a case fatality rate of 90%, versus 10% for all other methods combined, 4,62,63 reducing access to firearms and other lethal means among those with suicide risk may prevent suicide deaths, 64 and is part of the National Strategy for Suicide Prevention.…”