Mills Peter D, DeRosier Joseph M, Ballot Bryan A, Shepherd Michael, Bagian James P
Field Office of the National Center for Patient Safety, Veterans Health Administration, White River Junction, Vermont, USA.
Jt Comm J Qual Patient Saf. 2008 Aug;34(8):482-8. doi: 10.1016/s1553-7250(08)34061-6.
Suicide is the eleventh leading cause of death in the United States. Approximately 1,500 suicides occur in inpatient hospital units in the United States each year. In an attempt to determine the methods and environmental factors involved in inpatient suicide and suicide attempts in Department of Veterans Affairs (VA) hospitals, all root cause analysis (RCA) reports of inpatient suicides and suicide attempts submitted to the VA National Center for Patient Safety (NCPS) before June 2006 were reviewed.
VA medical centers are required to conduct RCAs on all inpatient suicides and report all suicides and serious suicide attempts to the NCPS. All reports of inpatient suicide and suicide attempts submitted between December 1999 and June 2006 were reviewed, including methods and environmental factors involved in the events.
A total of 185 inpatient suicide and suicide attempts were reported; 42 were completed suicides and 143 were suicide attempts. Approximately 52% of the total number of events occurred while the patient was on an inpatient psychiatry unit. Three methods of self harm--intentional drug overdose, cutting with a sharp object, and hanging--accounted for 71% of the total number of events. Doors and wardrobe cabinets accounted for 41% of the anchor points when hanging was the method of self-harm. For suicide attempts involving cutting behaviors, razor blades accounted for 37% of the total number of events; 57% of jumping-related events occurred from balconies and walkways.
Careful review of RCA reports of inpatient suicide has resulted in focused interventions to improve patient care and patient safety in VA medical centers, including a comprehensive environment-of-care checklist for reviewing inpatient psychiatry units.
自杀是美国第十一大死因。美国每年约有1500例自杀事件发生在住院病房。为了确定退伍军人事务部（VA）医院住院患者自杀及自杀未遂所涉及的方法和环境因素，我们对2006年6月之前提交给VA国家患者安全中心（NCPS）的所有住院患者自杀及自杀未遂的根本原因分析（RCA）报告进行了审查。
VA医疗中心必须对所有住院患者自杀事件进行RCA，并向NCPS报告所有自杀及严重自杀未遂事件。我们审查了1999年12月至2006年6月期间提交的所有住院患者自杀及自杀未遂报告，包括事件所涉及的方法和环境因素。
共报告了185例住院患者自杀及自杀未遂事件；42例为自杀死亡，143例为自杀未遂。在所有事件中，约52%发生在患者住院精神科病房期间。三种自我伤害方式——故意药物过量、用锐器割伤和上吊——占事件总数的71%。当自杀方式为上吊时，门和衣柜占固定点的41%。在涉及割伤行为的自杀未遂事件中，剃须刀片占事件总数的37%；57%的与跳楼相关的事件发生在阳台和走道。
对住院患者自杀的RCA报告进行仔细审查，已促成有针对性的干预措施，以改善VA医疗中心的患者护理和患者安全，包括用于审查住院精神科病房的全面护理环境检查表。
