Riblet Natalie, Shiner Brian, Mills Peter, Rusch Brett, Hemphill Robin, Watts Bradley V
Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States.
Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States.
Gen Hosp Psychiatry. 2017 May;46:68-73. doi: 10.1016/j.genhosppsych.2017.03.009. Epub 2017 Mar 28.
Medical hospitalization is a high risk period for suicide. It is important to understand system-level factors that may be associated with suicide after a medical hospitalization.
Retrospective study of root-cause analysis (RCA) reports of suicide occurring within three months of Veterans Administration (VA) medical hospitalization, 2002-2015. We collected patient and system-level factors to characterize events.
There were 96 RCA reports pertaining to suicide within three months of medical hospitalization. A total of 168 root causes for suicide were identified and fell into three major themes including: management of known suicide risk (N=73, 43%), decision making to monitor suicide risk (N=48, 29%), and patient engagement in treatment (N=47, 28%). RCA reports raised concerns that medical teams did not provide mental health treatment when indicated and lacked a standardized process for assessing psychological well-being in patients with a serious medical illness. In 25 cases, patients declined recommended treatment and in 15 cases, patients left against medical advice (AMA).
Challenges with patient engagement in treatment and lack of standardized processes for assessing and managing suicide risk may play an important role in suicide risk after medical hospitalization. Additional high quality studies are needed to confirm our findings.
医疗住院期间是自杀的高风险期。了解可能与医疗住院后自杀相关的系统层面因素非常重要。
对2002年至2015年退伍军人事务部（VA）医疗住院后三个月内发生的自杀事件的根本原因分析（RCA）报告进行回顾性研究。我们收集了患者和系统层面的因素来描述这些事件。
有96份RCA报告涉及医疗住院后三个月内的自杀事件。共确定了168个自杀的根本原因，分为三个主要主题，包括：已知自杀风险的管理（N = 73，43%）、监测自杀风险的决策（N = 48，29%）以及患者参与治疗（N = 47，28%）。RCA报告提出了对医疗团队的担忧，即在有指征时未提供心理健康治疗，且缺乏评估重症患者心理健康的标准化流程。在25例中，患者拒绝了推荐的治疗，在15例中，患者擅自离院（AMA）。
患者参与治疗方面的挑战以及缺乏评估和管理自杀风险的标准化流程可能在医疗住院后的自杀风险中起重要作用。需要更多高质量研究来证实我们的发现。
