Joint Commission Issues Suicide Alert for ED, Med/Surg

Cheryl Clark, November 18, 2010

Hospital caregivers should step up their lookout for non-psychiatric patients who may be at risk for attempted suicide, especially in the emergency department and in medical/surgical units, the Joint Commission has announced in a Sentinel Alert.

More than 800 such suicides in hospitals have been reported to the commission since 1995.

"It is evident from the number of incidents reported that general hospitals must take action to prevent patient suicides. The mental as well as physical needs of patients must be addressed to prevent these tragic consequences," says commission president Mark R. Chassin, MD.

While psychiatric care settings have trained staff who know to look for suicidal behavior, staff in medical/surgical units and emergency department aren't necessarily evaluating the patient for psychiatric or suicide attempt risk.

"It is noteworthy that many patients who kill themselves in general hospital inpatient units do not have a psychiatric history or a history of suicide attempt. They are unknown at risk for suicide," the alert says.

"Compared to the psychiatric hospital and unit, the general hospital setting also presents more access to items that can be used to attempt suicide—items that are either already in or may be brought into the facility—and more opportunities for the patient to be alone to attempt or re-attempt suicide."

Suicide is one of the five serious events occurring in hospitals most often reported to the commission, and nearly 25% occurred in non-psychiatric settings, the commission reports.

Some risk factors for these non-psychiatric patients may include traumatic brain injury, dementia, chronic pain or intense acute pain, poor prognosis or terminal diagnosis and substance abuse.

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