KNOWLEDGE, ATTITUDES, AND PRACTICES OF EMERGENCY DEPARTMENT PROVIDERS IN THE CARE OF SUICIDAL PATIENTS

Authors

  • Marian E. Betz M.D., M.P.H.,

    Corresponding author
    • Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
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  • Ashley F. Sullivan M.S., M.P.H.,

    1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • Anne P. Manton Ph.D., A.P.R.N.,

    1. Cape Cod Hospital, Hyannis, Massachusetts
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  • Janice A. Espinola M.P.H.,

    1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • Ivan Miller Ph.D.,

    1. Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island
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  • Carlos A. Camargo Jr. M.D. Dr.P.H.,

    1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • Edwin D. Boudreaux Ph.D.,,

    1. Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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  • on behalf of the ED-SAFE Investigators


  • ED-SAFE Investigators: Michael H. Allen, M.D. (University of Colorado School of Medicine); Edward Boyer, M.D., Ph.D. (University of Massachusetts); Jeffrey Caterino, M.D., M.P.H. (Ohio State University Medical Center); Robin Clark, Ph.D. (University of Massachusetts); Mardia Coleman (University of Massachusetts Medical School); Barry Feldman, Ph.D. (University of Massachusetts Medical School); Amy Goldstein, Ph.D. (National Institute of Mental Health); Talmage Holmes, Ph.D. (University of Arkansas for Medical Sciences Medical Center); Maura Kennedy, M.D. (Beth Israel Deaconess Medical Center); Frank LoVecchio, D.O. (Maricopa Medical Center); Sarah Arias, Ph.D. (Massachusetts General Hospital); Lisa Uebelacker, Ph.D. (Memorial Hospital of Rhode Island); Wesley Zeger, D.O. (University of Nebraska Medical Center)

  • Contract grant sponsor: National Institute of Mental Health; Contract grant number: U01MH088278.

Correspondence to: Marian E. Betz, M.D., M.P.H., Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue B-215, Aurora, CO 80045. E-mail: marian.betz@ucdenver.edu

Abstract

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.

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