New Emergency Nurses Association study identifies process improvements for suicide screenings in ED

DES PLAINES, Ill. – New research from the Emergency Nurses Association encourages more in-depth suicide screenings in the emergency department in an effort to better identify individuals at risk for suicide. The study, recently published in the Journal of Emergency Nursing, explores current screening procedures while identifying opportunities for improvement.

According to the Centers for Disease Control and Prevention, suicide is the tenth leading cause of death in the U.S., and research shows a substantial percentage of people who die by suicide present for healthcare in the year before their deaths. Screening for suicidality is a critical nursing function in the ED and provides healthcare professionals an opportunity to identify patients at risk for suicide and intervene appropriately.

Current literature reports that approximately 12.5 percent of ED visits are for behavioral health problems making it a common presentation. Only 3 percent of emergency patients will disclose suicidal thoughts, but studies show up to 12 percent have some suicidal ideation.

Study participants identified effective assessment processes that include verbal and non-verbal cues such as observation of an individual’s behavior, reaction to questioning, emotional affect and physical demeanor. Findings indicate that effective and accurate suicidality assessment is conducted over the course of the patient’s ED stay, and occurs not by asking a single question but in conjunction with assessment of patient behaviors and presentation. Participants specified that better education, improved practice resources and environmental changes will have the most impact when it comes to recognizing suicide risk at triage.

“Asking one simple question at the triage encounter isn’t enough to identify a potentially suicidal patient,” said lead researcher and Director of ENA’s Institute for Emergency Nursing Research Lisa Wolf, PhD, RN, CEN, FAEN. “These new findings may help ED nurses and physicians create a standard protocol to better identify suicidal patients over the course of the care trajectory, and provide the appropriate intervention before it’s too late.”

Researchers hope hospital administrators review this study and use it as an opportunity to: better inform emergency nurses on non-verbal signs of suicide risk; develop a go-to checklist of questions with a guided protocol of steps to follow for someone who has been red flagged; and create a safe, private environment to conduct those difficult conversations with a patient.

Forty-one emergency nurses participated in two focus groups to share their experiences with suicide-risk assessments and current practice challenges for this study.