Suicide Assessment in the ED
Literature based recommendations for suicide assessment in the Emergency Department: A review. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 836–842, 2012
Linda Ronquillo, MA, Arpi Minassian, PHD, Gary M. Vilke, MD, and Michael P. Wilson, MD, PHD.
Suicidal ideation and suicide attempts are frequent complaints in the ED. The Joint Commission established a National Patient Safety Goal that requires practitioners who are taking care of patients with psychiatric and behavioral disorders to identify patients who are at high risk for suicide. However, it can be difficult to identify which patients are truly high risk for suicide, and psychiatric holds and psychiatric consults can take up valuable time and space in the ED. The goal of this article is to provide a comprehensive literature review to discuss appropriate management of suicidal patients and identify important variables to distinguish patients at high risk for suicide.
-Use safety contracts cautiously; experts agree it does not offer you legal protection in the event of a poor outcome.
-Strong predictors of suicide include: previous history of suicide attempts, current lethal plan, recent psychosocial stressor, hopelessness, psychosis, older age, Caucasian race, and previous psychiatric diagnosis.
-Alcohol and drug use increase overall lifetime suicide risk, and can increase risk acutely if patient’s judgement is impaired and is impulsive. However, not all patients with substance abuse require immediate psychiatric evaluation, particularly if they do not have other specific risk factors such as hopelessness or psychosocial stressors.
-There is no universally accepted scoring system to identify patients high risk for suicide. Two scoring systems discussed (modified SAD PERSONS, The Manchester Self-Harm Score) simply take into account key history elements discussed above, and are not sensitive enough to be relied on completely. However, they may be helpful in identifying low risk patients who are safe to discharge with outpatient psychiatric follow up.
-Take a good history of suicidal patients in the ED to ask about key variables (current lethal plan, previous suicide attempts, hopelessness) that can help identify patients high risk for completing suicide. Patients who do not have any of these features may be appropriate for outpatient care.