Suicide prevention in the emergency department

BACKGROUND: Emergency departments (EDs) are frequently the first treatment site for individuals who have attempted suicide. Further, many people with suicidal ideation present to the ED with complaints seemingly unrelated to their suicidality. One state's Violent Death Reporting System data showed that almost half of the annual suicide deaths had been to the ED in the two years prior to the death; 10% had been seen within 2 months of death.

METHODS: The Suicide Prevention Resource Center developed materials to help ED staff identify and manage suicidal patients. Poster content was developed by a panel of nationally recognized experts including ED nurses and physicians, psychologists and emergency psychiatrists. Two successive draft posters were tested through multiple focus groups with ED nurses and physicians, getting input on content, format, placement, utility, and appropriate audience.

RESULTS: Focus group results led to a more succinct poster, with additional material formatted into an accompanying guide. Focus groups selected taglines they judged to be more relevant than those proposed by the experts. Prominent logos of endorsing emergency health and suicide prevention organizations add credibility to the materials. The Emergency Nurses Association (ENA) disseminated the materials to their membership. Planning is underway to evaluate the materials through a multi-site RCT.

CONCLUSIONS: New surveillance data identify the ED as a key locus of injury prevention for suicidal individuals. Involving the target audience in design of interventions increases the acceptability and potential effectiveness of educational materials. Evaluation is necessary to measure the utility and effectiveness of such materials.