Predictive utility of an emergency department decision support tool in patients with active suicidal ideation.

Abstract

Emergency department (ED) clinicians routinely decide the disposition of patients with suicidal ideation, with potential consequences for patient safety, liability, and system costs and resources. An expert consensus panel recently created a 6-item decision support tool for patients with passive or active suicidal ideation. Individuals scoring a 0 (exhibiting none of the tool's 6 items) are considered "lower risk" and suitable for discharge, while those with non-0 scores are considered "elevated risk" and should receive further evaluation. The current study tested the predictive utility of this tool using existing data from the Emergency Department Safety Assessment and Follow-up Evaluation. ED patients with active suicide ideation (n = 1368) were followed for 12 months after an index visit using telephone assessment and medical chart review. About 1 in 5 patients had attempted suicide during follow-up. Because of the frequency of serious warning signs and risk factors in this population, only three patients met tool criteria for "lower risk" at baseline. The tool had perfect sensitivity, but exceptionally low specificity, in predicting suicidal behavior within 6 weeks and 12 months. In logistic regression analyses, several tool items were significantly associated with suicidal behavior within 6 weeks (suicide plan, past attempt) and 12 months (suicide plan, past attempt, suicide intent, significant mental health condition, irritability/agitation/aggression). Although the tool did not perform well as a binary instrument among those with active suicidal ideation, having a suicide plan identified almost all attempters while suicide plan and past attempt identified over four-fifths of near-term attempts. (PsycINFO Database Record

The Prioritization of Lean Techniques in Emergency Departments Using VIKOR and SAW Approaches

“…For this purpose, a total of 11 Lean techniques used at medical centers were obtained using library studies and investigating previous research. These techniques include 5S, Six Sigma, VSM, Kanban, Kaizen, Jiduka, TOC, Poka-yoke, logic tree, seven waste, and matrix x which are used in (1,(25)(26)(27)(28)(29)(30)(31). Finally, using experts' opinions, five techniques that were more applicable in ED were selected.…”

Estratégias Adotadas Pelos Serviços De Emergência Frente a Tentativa De Suicídio

“…Outros dois estudos 24,25 adotaram essa estratégia de acompanhamento telefônico por um ano. Um deles 25 contatou os pacientes com seis, 12, 24, 36 e 52 semanas após intento, e realizou avaliação para detectar os que tinham baixo e alto risco para nova tentativa de suicídio.…”

“…Sendo necessário além de uma ferramenta de avaliação de risco, o levantamento dos fatores predisponentes e de uma avaliação clínica qualificada como parte de uma abordagem abrangente e centrada no paciente. O que corrobora com o outro estudo 24 , onde além do contato telefônico, o paciente recebia um plano de segurança e informações fornecidos pela equipe de enfermagem e na ausência do atendimento telefônico, ocorria o encaminhamento de cartas demonstrando preocupação com o mesmo. O referido estudo demonstrou que a combinação dessas breves intervenções durante e após alta da emergência, diminuíram o comportamento suicida.…”

Assessing psychiatric safety in suicidal emergency department patients

“…A large proportion of Americans have one of these risk factors, but only a small proportion will attempt suicide, and even fewer will die by it . A recent study, however, found that having a suicide plan and a history of past attempts has a high sensitivity for identifying risk of suicide in the 6 weeks following hospital discharge . Thus, an ED suicide risk assessment may, therefore, enable identification of patients with suicidal ideation and facilitate initiation of appropriate treatment.…”

“…22 A recent study, however, found that having a suicide plan and a history of past attempts has a high sensitivity for identifying risk of suicide in the 6 weeks following hospital discharge. 23 Thus, an ED suicide risk assessment may, therefore, enable identification of patients with suicidal ideation and facilitate initiation of appropriate treatment. Although risk assessment is an inexact science, the goal is to assess the patient's history, current mental state, home environment, and specific suicidal thoughts or behaviors.…”