Problems of suicide risk management in the emergency department without fixed, full-time emergency physician

Attempted suicide is an often neglected emergency care problem in Taiwan. Using rotating subspecialty residents on emergency room duty and providing them with "Suicide Risk Assessment" sheets and clear disposition criteria, we wished to see if we could improve patient management while at the same time compiling demographic data. From December 1990 to May 1991 we prospectively collected 96 cases. The majority were female, ages 19-40. Twelve patients died, with agricultural poisonings the major cause. The SAD PERSONS scale consistently underestimated the suicide risk, and disposition plans were rarely followed. Only 20% of low risk patients were seen by social service. In the intermediate risk group 64% were discharged despite meeting admission criteria. In the high risk group 33% were also discharged and only one transferred to a psychiatric facility. Without fixed, full time physicians willing to establish and comply with standards of care, the management is unlikely to improve. Well trained Emergency attendings would be an appropriate solution.