Non-Causative Discharge Diagnosis from the Emergency Department and Risk of Suicide

Gunnarsdóttir, Oddný Sigurborg; Rafnsson, Vilhjálmur

doi:10.1016/j.jemermed.2007.09.061

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…The indication for decreased mortality for all causes among those with non-causative diagnosis as compared with other patients has already been mentioned, but furthermore, there was decreased mortality due to disease of the circulatory system through the three follow-up intervals and increased mortality due to neoplasm and suicide. The association between non-causative diagnosis and suicide has been reported previously [15,16], but it is a novelty that this association is statistically significant for suicide within 15 and 30 days after discharge from the ED. A prospective feasibility study on occult suicidality disclosed a high rate of suicidal ideation and thoughts about killing themselves among ED users [17], and these suicidal ideations and planning were rarely detected by the physicians of the ED.…”

Section: Discussionmentioning

confidence: 61%

All-cause mortality and suicide within 8 days after emergency department discharge

Rafnsson

Gunnarsdóttir

2013

Scand J Public Health

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Section: Discussionmentioning

confidence: 61%

All-cause mortality and suicide within 8 days after emergency department discharge

Rafnsson

Gunnarsdóttir

2013

Scand J Public Health

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“…As many as 25-70 % of people who died by suicide visited emergency departments for non-suiciderelated reasons shortly before their death [8][9][10]. Discharge from emergency departments with a non-causative diagnosis is associated with higher subsequent suicide risk [11][12][13]. In other words, the ER represents an important setting that can make a tremendous impact upon patient safety and well being.…”

Section: Introductionmentioning

confidence: 99%

Suicide Attempts After Emergency Room Visits: The Effect of Patient Safety Goals

Robst

2015

Psychiatr Q

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In 2007 the Joint Commission National Patient Safety Goals included a requirement addressing risks associated with patient suicidality. The rational for this requirement was that suicide has been the most frequently reported sentinel event since the inception of the Sentinel Event Policy in 1996. The Patient Safety Goals on suicide required hospitals implement actions to assess suicide risk, meet client's immediate safety needs and provide information such as a crisis hotline to individuals and family members for crisis situations. This study performed a secondary data analysis to assess the effect of the 2007 Joint Commission Patient Safety Goals on suicide attempts among patients following treatment at hospital emergency rooms among individuals enrolled in the Florida Medicaid program. A difference-in-difference approach compared changes in rates of suicide attempts for individuals with a primary mental health diagnosis and individuals with a physical health diagnosis after emergency room treatment. In the 6 months following treatment, suicide rates declined after implementation of the goals among patients treated for a primary mental health diagnosis, and increased among patients with a poisoning diagnosis, compared to individuals with a physical health diagnosis. The goals were associated with a reduction in suicide attempts after emergency room treatment.

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“…), 9–12 and the increase in alcohol-related visits and suboptimal management at the ED calls for action. 12 The imminent and long-term mortality risks of drunken patients in the ED have only rarely been studied, 13 although mortality investigations have been undertaken repeatedly on patients with a clinical diagnosis of AUDs or persons with AUDs identified in general population surveys. 1–5 Increased all-cause mortality of AUD patients from the ED was found in a small study 13 with excess death from injuries and suicide.…”

Section: Introductionmentioning

confidence: 99%

“… 12 The imminent and long-term mortality risks of drunken patients in the ED have only rarely been studied, 13 although mortality investigations have been undertaken repeatedly on patients with a clinical diagnosis of AUDs or persons with AUDs identified in general population surveys. 1–5 Increased all-cause mortality of AUD patients from the ED was found in a small study 13 with excess death from injuries and suicide. The setting at the ED of Landspitali—the National University Hospital of Iceland (LUH), which is the only acute care hospital serving the population of the capital area of Reykjavik, offers a unique opportunity to study the survival of those with alcohol diagnosis through the nationwide death registry.…”

Section: Introductionmentioning

confidence: 99%

Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study

et al. 2014

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ObjectivesThe aim was to study the cause-specific mortality of users of the emergency department (ED) who received a diagnosis of alcohol use disorder (AUD) in comparison with mortality of other users of the department.DesignA population-based prospective cohort study.ParticipantsAll patients aged 18 years and above who were subsequently discharged home from the ED during the years 2002–2008. A total of 107 237 patients were followed by record linkage to a nationwide cause-of-death registry: 1210 patients with AUD as the main discharge diagnosis and 106 027 patients in the comparison group. HR and 95% CIs were calculated.SettingED at Landspitali—the National University Hospital of Iceland, Reykjavik, Iceland. The hospital offers tertiary care and is the number one trauma centre and community hospital for the greater Reykjavik area. According to the population registry, 78% of the inhabitants of the area attended the ED during the study period.Results72 patients died in the AUD group and 4807 in the comparison group. The adjusted HR for all causes of death was 1.91 (95% CI 1.51 to 2.42). The HR for AUDs was 47.68 (95% CI 11.56 to 196.59) while for alcohol liver disease the HR was 19.06 (95% CI 6.07 to 59.87). The HR was also elevated for diseases of the circulatory system: HR 2.52 (95% CI 1.73 to 3.68); accidental poisoning: HR=13.64, (95% CI 3.98 to 46.73); suicide: HR=2.72 (95% CI 1.08 to 6.83); and event of undetermined intent: HR=10.89 (95% CI 4.53 to 26.16).ConclusionsAUD as the discharge diagnosis at the ED, among patients who were not admitted to a hospital ward but discharged home, predicts increased mortality. As the results conclusively show the vulnerability of these patients, one can question whether their needs are adequately met at the ED.

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Non-Causative Discharge Diagnosis from the Emergency Department and Risk of Suicide

Cited by 4 publications

References 26 publications

All-cause mortality and suicide within 8 days after emergency department discharge

All-cause mortality and suicide within 8 days after emergency department discharge

Suicide Attempts After Emergency Room Visits: The Effect of Patient Safety Goals

Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study

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