Management of the Suicidal Patient in the Emergency Department

White Paper
Prepared by Horizon Health Behavioral Health Services

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The Suicidal Patient in the Emergency Department

Suicide is one of the top ten causes of death in the United States, claiming twice as many lives each year as homicide. Over the past several years we have witnessed a gradual increase of suicidal patients seeking care in hospital emergency departments (ED). In many situations, the staff caring for these patients is not adequately prepared to address the multi-dimensional issues that contribute to the patient’s dire situation. This trend, unfortunately, is not expected to dissipate in the foreseeable future. The ED has become the stop-gap plan for behavioral health crises due to shrinking community resources and lack of psychiatric services and beds. The reality is, that for every person who completes a suicide, more than 30 others attempt suicide, and thus present extraordinary clinical challenges for ED staff.

The Joint Commission’s 2014 National Patient Safety Goal 15.01.01 mandates that hospitals identify patients at risk for suicide. This requires an assessment process that identifies patients at risk, and recognizes environmental factors that may affect the patient’s risk level for suicide. There is also a requirement to immediately address the safety needs of the patient, including the patient’s safety during their stay in the ED. Hospitals are required to provide suicide prevention information to each patient and their family member(s) when a patient that is potentially at risk for suicide is discharged. To meet these requirements, hospitals must take a comprehensive and thorough approach to managing the suicidal patient in the ED, and identify and develop an appropriate discharge disposition. If you would like to evaluate your ED’s level ofreadiness to handle these patients, consider the following questions:

Does your ED have a comprehensive approach to meet the needs of the suicidal patient and their families? For instance,

  • Is your suicide risk assessment process evidence-based to provide appropriate evaluation and recommendations for treatment?
  • Is your ED staff educated and supported by behavioral health providers to recognize the warning signs of patients at risk for suicide?
  • Do you have policies and procedures in place specific to this patient population?
  • Does your staff follow trauma-informed policies to ensure the patient is treated with respect and in a way that promotes healing and recovery?
  • Does your documentation include a clear and concise review of risk and protective factors and the measures taken to ensure patient safety?

Is your ED staff challenged when dealing with suicidal patients and their families? Specifically,

  • Is there an awareness of specific groups and their clinical presentations that identifies these groups as higher risk than the general population for suicidal behaviors?
  • Is your staff providing appropriate referrals to ensure continuity of care and reduce risk once the patient leaves your ED?
  • Does your staff recognize that patients who present with self-harm injuries are 100 times more at risk of suicide than the general population?
  • Does your staff follow written standardized protocols based on common clinical presentations to allow for more differentiated responses based on each patient’s risk profile and assessed needs?
  • Has your ED developed guidelines and competencies to effectively engage families and concerned others as appropriate throughout the care of persons with suicide risk?

The Horizon Solution

Over 40 years of experience managing and operating behavioral health programs in acute care hospitals across the United States has prepared Horizon Health Behavioral Health Services to better coordinate the needs of the ED and suicidal patient. Horizon has the experience to engage EDs and behavioral health programs to develop and provide state-of-the-art assessment centers to enhance the safety of patients with suicide risk.

Horizon begins each evaluation by completing a comprehensive assessment of the ED environment to provide recommendations that will decrease potential environmental risks. Horizon partners with our client hospitals to identify strategies to decrease risks associated with suicidal patients through:

  • Audit of risk assessments
  • Development of assessment tools and policies to improve patient care
  • Staff education in the management of the suicidal patient

For an evaluation of your ED procedures in assessing, treating and referring suicidal patients, contact an organization with more than 40 years of experience, expertise and clinical resources to better manage the suicidal patient in your emergency department.

Let’s Get to Work, Together

Contact us to learn more about how Horizon Health can help you start a behavioral health program or take an existing program to new heights.