Fertel Baruch S, Pozuelo Leopoldo, Kirschling Sarah, Worley Sarah, Simon Erin L, Muir McKinsey, Smalley Courtney M
Quality & Patient Safety New York - Presbyterian Hospital, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, United States of America.
Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, United States of America.
Am J Emerg Med. 2023 Oct;72:127-131. doi: 10.1016/j.ajem.2023.06.051. Epub 2023 Jul 26.
Suicidal ideation is a common complaint in Emergency Departments (EDs) across the United States (US) and is an important preventable cause of death. Consequently, current Joint Commission guidelines require screening high-risk patients and those with behavioral health needs for suicide. Accordingly, we implemented universal suicide screening for all patients presenting to EDs in our healthcare system and sought to describe the characteristics of the identified "high-risk" patients. We also sought to determine whether universal suicide screening was feasible and what its impact was on ED length of stay (LOS).
All ED encounters in the healthcare system were assessed. Data were collected from February 1, 2020, through June 30, 2022. All patients aged 18 and over were screened using the Columbia Suicide Severity Rating Scale (C-SSRS) and categorized as no risk, low risk, moderate risk, and high risk. Encounters were then grouped into 'high risk" and "not high risk," defined as no, low, and moderate risk patients. Data collected included gender, discharge disposition, LOS, and insurance status.
A total of 1,058,735 patient encounter records were analyzed. The "high risk" group (n = 11,359; 10.7%) was found to have a higher proportion of male patients (50.9 vs 43.7%) and government payors (71.6 vs. 67.1%) and a higher ED LOS [medians 380 min vs. 198 min] than the not high-risk group (p ≤0.001). Those with suicidal ideation comprised 0.73-1.58% of ED encounters in a given month. A secondary analysis of 2,255,616 ED encounter records from January 2019 - June 30, 2022, revealed that 40,854 (1.81%) encounters required 1:1 observation. The proportion of 1:1 observations in 2019, the year before implementation, was 1.91%. Using a non-inferiority margin of 25%, we found that the proportion of 1:1 patients in 2020, the year following implementation, was non-inferior to (no worse than) the previous year at 2.09% and decreased from 2021 to 2022 (1.69% and 1.57% respectively).
Implementing universal suicide screening in all EDs within a healthcare system is feasible. The percentage of patients who screened high risk was under 5% of the overall ED population. While the median LOS was longer for "high-risk" patients than for the general ED population, it was not excessively so. Adequate staffing to properly maintain the safety of these patients is paramount.
自杀意念是美国急诊科常见的主诉，是一种重要的可预防死因。因此，当前联合委员会指南要求对高危患者和有行为健康需求的患者进行自杀筛查。据此，我们对医疗系统中所有到急诊科就诊的患者实施了普遍自杀筛查，并试图描述已识别出的“高危”患者的特征。我们还试图确定普遍自杀筛查是否可行以及其对急诊科住院时间（LOS）有何影响。
对医疗系统中的所有急诊科就诊情况进行评估。数据收集时间为2020年2月1日至2022年6月30日。所有18岁及以上患者使用哥伦比亚自杀严重程度评定量表（C-SSRS）进行筛查，并分为无风险、低风险、中度风险和高风险。然后将就诊情况分为“高危”和“非高危”，“非高危”定义为无风险、低风险和中度风险患者。收集的数据包括性别、出院处置、住院时间和保险状况。
共分析了1,058,735份患者就诊记录。发现“高危”组（n = 11,359；10.7%）男性患者比例（50.9%对43.7%）和政府支付方比例（71.6%对67.1%）更高，且急诊科住院时间中位数[380分钟对198分钟]比非高危组更长（p≤0.ooo1）。在给定月份，有自杀意念的患者占急诊科就诊患者的0.73 - 1.58%。对2019年1月至2022年6月30日的2,255,616份急诊科就诊记录进行的二次分析显示，40,854次（1.81%）就诊需要一对一观察。实施前一年即2019年的一对一观察比例为1.91%。使用25%的非劣效性边际，我们发现实施后一年即2020年一对一观察患者的比例不劣于（不低于）上一年，为2.09%，且从2021年到2022年有所下降（分别为1. .69%和1.57%）。
在医疗系统内的所有急诊科实施普遍自杀筛查是可行的。筛查出的高危患者百分比占急诊科总人数的5%以下。虽然“高危”患者的住院时间中位数比急诊科普通人群更长，但并非过长。配备足够的人员以妥善保障这些患者的安全至关重要。
