Preventing suicide among ED patients – a realizable goal | Joint Commission
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Preventing suicide among ED patients – a realizable goal

Oct 16, 2013 | 11733 Views

By Paul M. Schyve, M.D.,
Senior Advisor
The Joint Commission

Schyve 11 10Emergency departments are busy places. Physicians and other staff can be hurried as they respond to the challenges of helping – and often saving – the patients who arrive in the ED with life-threatening or urgent conditions. Despite the physicians’ best efforts, some patients die – and the physician is sorrowful and expresses sympathy to the family.  But hardest is when a patient dies and we know we could have prevented the death. Now we feel guilt and shame, and struggle to express our apology and sympathy to the family. We are victims of the unnecessary death, just as are the patient and the family.

An immediately recognizable unnecessary death in an ED is a suicide that was initiated in the ED itself.  These suicides need not occur if suicidal patients are recognized, appropriate immediate protective interventions are put in place, and the patients are successfully transitioned to definitive treatment, whether inpatient or outpatient. When suicide occurs in the ED, it is usually the result of a failure to recognize that a patient is suicidal, to assure that the suicidal patient does not have access to a means for suicide, to communicate to other staff that the patient is suicidal, or to make an assured transition to another clinician – all of which are within the control of the physician and the other health care workers in the ED. We can and must eliminate suicides that are initiated in the ED.

Yet ED physicians and staff are often not specifically trained to recognize suicidal patients – especially for patients who may not have a psychiatric history or history of suicide attempt. Because of the frequency of these preventable deaths, The Joint Commission requires hospitals to conduct a risk assessment to identify individual characteristics and environmental features that increase or decrease the risk for suicide, to address a suicidal patient’s immediate safety needs, and to make assured transitions to appropriate care when the patient leaves the ED.

Based on the reports of inpatient and ED suicides – and of their root causes – submitted to The Joint Commission’s Sentinel Event database, and on advice from experts in suicide prevention, The Joint Commission issued a four-page Sentinel Event Alert in 2010 on preventing suicide in medical/surgical units and the emergency department. This Alert contains practical advice for physicians and for medical/surgical hospitals on reducing suicide in these settings. Like all Joint Commission Sentinel Event Alerts, this Alert is available at no cost on the Joint Commission website.

From the time of Hippocrates, our obligation has been to save lives; here is one way we can do so.



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