Addressing Positive Suicide Screens in the Emergency Department: The Importance of Post-Discharge Follow-up

Suicide is the tenth leading cause of death and many of those who die by suicide have visited an emergency department (ED) in the months prior to their death. Thus, identification and treatment of suicidal ideation (SI) in the ED is essential to suicide prevention efforts. Although a recent effort to implement universal SI screening has identified more patients with suicide risk, there are still barriers to further risk assessment and intervention, including: patients being too ill, language differences, physician caseload, length of SI evaluation and intervention, staff availability and communication with emergency mental health (EMH) services, and stigma surrounding risk responsibility. To address these issues following the Zero Suicide Model, in November 2017 the pre-existing Behavioral Health Service (BHS) expanded their care to this population, improved communication with EMH to reduce patient burden, and implemented a follow-up call system to contact patients within 48 hours post-discharge. Since November, 61 patients were identified as not receiving further SI evaluation or resources while in the ED. Twenty-four (39.3%) of these patients were successfully contacted by phone, with 15 (62.5%) receiving resources and 9 (37.5%) declining resources due to existing services. All patients with available addresses (86.8%) were sent Caring Contact Cards with information on suicide hotlines and psychiatric emergency services. By attempting calls multiple times, mailing resources, and being brief, yet detailed when evaluating, more patients' SI needs are being treated. The ultimate goal is to provide services to all patients who screen positive for suicide risk presenting to the ED.