Knowledge, Attitudes, and Practices of Emergency Department Providers in the Care of Suicidal Patients
Department of Emergency Medicine; Department of Psychiatry; Center for Health Policy and Research
Medical Subject Headings
Suicide; Suicidal Ideation; Suicide, Attempted; Emergency Service, Hospital; Emergency Medical Services; Mental Health Services
Emergency Medicine | Health Services Administration | Health Services Research | Mental and Social Health | Psychiatry | Psychiatry and Psychology
BACKGROUND: We sought to examine the knowledge, attitudes, and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI).
METHODS: Six hundred thirty-one providers at eight EDs completed a voluntary, anonymous survey (79% response rate).
RESULTS: The median participant age was 35 (interquartile range: 30-44) years and 57% of the participants were females. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81-91%) than in skills to assess risk severity (64-70%), counsel patients (46-56%), or create safety plans (23-40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6-20%) or that suicidal patient treatment was almost always a top ED priority (15-21%). More nurses (37%, 95% confidence interval [CI] 31-42%) than physicians (7%, 95% CI 4-10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self-confidence in skills, (odds ratio [OR] 1.60, 95% CI 1.17-2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95% CI 1.11-2.69) and 5+ postgraduate years of clinical experience (OR 2.06, 95% CI 1.03-4.13).
CONCLUSIONS: ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling, or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.
Betz, Marian E.; Sullivan, Ashley F.; Manton, Anne P.; Espinola, Janice A.; Miller, Ivan; Camargo, Carlos A. Jr.; Boudreaux, Edwin D.; Boyer, Edward W.; Clark, Robin E.; Coleman, Mardia A.; Feldman, Barry N.; and ED-SAFE Investigators, "Knowledge, Attitudes, and Practices of Emergency Department Providers in the Care of Suicidal Patients" (2013). Emergency Medicine Publications and Presentations. 72.