Improving Suicide Risk Screening and Detection in the Emergency Department

Area of Science:

• Public Health
• Emergency Medicine
• Mental Health Research

Background:

• The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study investigated the implementation of universal suicide risk screening in emergency departments (EDs).
• The study aimed to assess the feasibility and effectiveness of improving suicide risk detection within the ED setting.

Purpose of the Study:

• To evaluate the impact of universal suicide risk screening on the documentation and detection of suicidal ideation and behavior in emergency departments.
• To determine the feasibility of integrating universal screening into routine ED care.

Main Methods:

• A three-phase interrupted time series design was employed across eight EDs from 2009-2014.
• Data collection included chart reviews for documented screening and patient interviews to confirm suicidal ideation/behavior.
• Statistical analyses utilized chi-square tests and generalized estimating equations to compare outcomes across phases.

Main Results:

• Documented suicide risk screenings increased from 26% to 84% after implementing universal screening and intervention phases.
• The detection rate of intentional self-harm ideation/behavior nearly doubled, rising from 2.9% to 5.7%.
• The majority of detected intentional self-harm cases were confirmed as recent suicidal ideation or behavior via patient interviews.

Conclusions:

• Universal suicide risk screening in EDs is a feasible strategy that significantly enhances the detection of individuals at risk for suicide.
• The findings suggest a substantial potential public health impact if these screening practices are widely adopted, as early identification is key to suicide prevention.