UMEM Educational Pearls

Category: International EM

Title: Which patients with suicidal ideation are safe to discharge?

Keywords: suicide, clinical policies, risk-assessment tools (PubMed Search)

Posted: 8/11/2017 by Jon Mark Hirshon, MD, MPH (Emailed: 8/16/2017) (Updated: 8/16/2017)
Click here to contact Jon Mark Hirshon, MD, MPH

Takeaways

In patients presenting to the ED with suicidal ideation, physicians should not use currently available risk-assessment tools in isolation to identify low-risk patients who are safe for discharge. The best approach to determine risk is an appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account. (Level C Recommendation, based upon the quality of the research.) 

In-Depth

As noted in a previous Pearl (see August 2, 2017), the American College of Emergency Physicians recently published a methodological rigorous clinical policy entitled “Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department.”

 

Another question addressed within the document was the following: “In the adult patient presenting to the ED with suicidal ideation, can risk-assessment tools in the ED identify those who are safe for discharge?”

 

They determined that in patients presenting to the ED with suicidal ideation, physicians should not use currently available risk-assessment tools in isolation to identify low-risk patients who are safe for discharge. The best approach to determine risk is an appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account. (Level C Recommendation, based upon the quality of the research.) 

References

http://www.annemergmed.com/article/S0196-0644(17)30070-7/fulltext