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Study: ED intervention reduces suicide attempts by 30%

How much of a role can emergency departments (ED) play in preventing suicide attempts? The world’s largest study of 1,376 suicidal patients gave the answer.

By implementing interventions at the ED, hospitals were able to lower the of risk patients attempting suicide again by 20% compared to if they are treated as usual (TAU). Researchers also found that “there were no meaningful differences in risk reduction between the TAU and screening phases.”

The study, called the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE), was the largest suicide intervention trial to date, covering patients from eight EDs and seven states.

“Results indicated that the provision of universal screening, while successful in identifying more participants, did not significantly affect subsequent suicidal behavior compared with that experienced by participants in the TAU phase,” they wrote. “By contrast, those participants who received the intervention had lower rates of suicide attempts and behaviors and fewer total suicide attempts over a 52-week period.”

With around 42,000 deaths annually, suicide is the seventh leading cause of death for American men, the 14th for American women, and the 10th overall. Annually, there are 460,000 ED visits that occur following cases of self-harm and a single ED visit due to self-harm increases future suicide risk by almost sixfold, according to the study.

The study compared a control group of patients who were given TAU, a group that was just screened, and one group that was screened along with interventions.

Intervention efforts included additional suicide screening, suicide prevention info, and a personalized safety plan for dealing with future suicide ideation, and periodic telephone follow-ups. Those who got these interventions made 30% fewer total suicide attempt than others.

“We were happy that we were able to find these results,” said lead author Ivan Miller, PhD, professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, in a statement. “We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging.”

Overall, 21% of those studied made at least one suicide attempt within 12 months. Those in the TAU group had a 22.9% suicide attempt rate, while in the screening group it was 21.5%. The intervention group only had a rate of 18.3%. Of all patients studied, there were five fatal suicide attempts.

Communicating patient rights with physcians and staff

You can have the best policies and procedures in the world, but if communication and understanding by those who need to know is not available, the intent of the patient rights chapter will never come to fruition. The chapter captain assigned to patients’ rights, with guidance from the accreditation director, should develop a communication plan to ensure that everyone in the organization understands his or her roles and the impact the chapter holds in relation to job responsibilities and functions.

The first step in a communication plan is to include aspects of this chapter in the job application form and credentials application. Those applying for jobs and physician privileges need not apply if they are not willing to adhere to and respect patients’ rights. For example, you could include the following language in your application:

By signing this application, I agree to treat patients and families with respect, ensure the patient’s privacy and confidentiality of health information, and to review the patient’s rights and responsibility notice.

Communication regarding patients’ rights should always be part of orientation to new board members, physicians, and staff. Some hospitals require all three groups to sign a document attesting that they will abide by and uphold these rights.

Ongoing communication is important for compliance with the patient rights chapter. In particular, the following topics should be considered for educational sessions or communication reminders:

  • Respecting cultural and personal values, beliefs, and preferences
  • Privacy and confidentiality
  • Understanding how patients understand (i.e., health literacy)
  • Advance directives and end-of-life decisions
  • Informed consent
  • Research/clinical trials
  • Dealing with disruptive people (e.g., physicians, staff, patients, family members)
  • Identifying neglect, exploitation, and verbal, mental, physical, and sexual abuse
  • Resolving patient complaints

Note: This blog post is an excerpt from The Chapter Leader’s Guide to Patient Rights: Practical Insight on Joint Commission Standards by Jean Clark, RHIA, CSHA.