The following is a summary of “Universal suicide screening in emergency departments across a large healthcare system,” published in the October 2023 issue of Emergency Medicine by Fertel, et al.

Suicidal ideation is a prevalent concern in Emergency Departments (EDs) and a significant preventable cause of death. To address it, universal suicide screening has been implemented in our healthcare system, aligning with Joint Commission guidelines. For a study, researchers sought to describe the characteristics of identified “high-risk” patients and assess the feasibility and impact of universal suicide screening on ED length of stay (LOS).

Data were collected from February 1, 2020, through June 30, 2022, encompassing all ED encounters in the healthcare system. Patients aged 18 and over were universally screened using the Columbia Suicide Severity Rating Scale (C-SSRS) and categorized as no risk, low risk, moderate risk, or high risk. Encounters were grouped into “high risk” and “not high risk.” Data included gender, discharge disposition, LOS, and insurance status.

Analysis of 1,058,735 patient encounter records revealed a “high-risk” group (n = 11,359; 10.7%) with a higher proportion of male patients (50.9 vs. 43.7%), government payors (71.6 vs. 67.1%), and a longer ED LOS [medians 380 min vs. 198 min] compared to the not high-risk group (P ≤0.001). Suicidal ideation cases comprised 0.73–1.58% of monthly ED encounters. A secondary analysis of 2,255,616 ED encounter records from January 2019 – June 30, 2022, indicated that 40,854 (1.81%) encounters required 1:1 observation, with the proportion remaining non-inferior to the year before universal screening. The proportion decreased in subsequent years (1.69% and 1.57% in 2021 and 2022, respectively).

Universal suicide screening in the healthcare system’s EDs was feasible, with less than 5% of the overall ED population identified as “high-risk.” While “high-risk” patients had a longer median LOS, it was not deemed excessively prolonged. Adequate staffing remained crucial for ensuring the safety of the patients.

Source: sciencedirect.com/science/article/abs/pii/S0735675723003431