It Works: Suicide Screening in the ED

Although it might seem silly, on the surface, to be discussing suicide risk when patients present at an emergency department for something completely unrelated, such efforts have been highly successful in identifying suicidal patients who might not have been identified any other way.

Newly released study results from University of Massachusetts Medical School in Worcester found that universal suicide risk screening in emergency departments nearly doubled the number of patients who were identified as thinking about or having attempted suicide. Suicide risk screenings among 236,791 ED visits over five years rose from 26% to 84%. As the screenings increased, so did detection of suicide risk: from 2.9% to 5.7%.

“Our study is the first to demonstrate that near-universal suicide risk screening can be done in a busy ED during routine care,” said lead author Edwin Boudreaux, PhD. “The public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.”

Published in the April issue of the American Journal of Preventive Medicine, “Improving Suicide Risk Screening and Detection in the Emergency Department” reports findings from the screening implementation part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. ED nurses were trained to administer a brief patient screening tool that focuses on three suicide risk factors: depressive symptoms, active suicidal ideation, and lifetime suicide attempts. A positive screen is any person who confirmed active suicidal ideation or reported a suicide attempt within the prior six months.

Patients who were identified as suicide risks received more evaluation and resources, including lists of community-based services, a self-help safety plan, and a wallet card with local suicide prevention lifeline numbers. In the study’s final phase, patients with positive screens could agree to receive structured telephone calls from trained nurses after discharge. The screening also identified some patients who needed psychiatric inpatient treatment. (The Joint Commission recently released a Sentinel Event Alert on suicide. For more information, see “Sounding the alarm about suicide risk” in our May issue of ED Management.)