The practice of suicide risk assessment for patients with self-harm in an emergency room and its associated factors

Abstract

Aim: Clinicians in emergency rooms (ERs) play critical roles in the care of patients at high risk for suicide. This study explored the practice of suicide risk assessment by front-line physicians in an ER and its associated factors. Methods: We conducted a single-center, retrospective chart-review study focusing on patients who were admitted to an emergency room following an episode of self-harm. We examined whether known risk factors for suicide were evaluated by front-line physicians in the ER. We also investigated the factors that were associated with the assessment for suicidal ideation from the following three perspectives: patient characteristics, medical-professional characteristics, and their working conditions. Results: A total of 499 episodes of self-harm were subjected to the analyses. The rate of suicide risk assessment varied widely among each risk factor. Patients’ suicidal ideation was less likely to be assessed when a patient was treated by non-psychiatrists, or when a patient presented with problematic behaviors (p<0.001, respectively). Emergency-medicine physicians are more likely to assess patients’ suicidal ideation than other non-psychiatrist physicians (p<0.05). Patients who were directly discharged from the emergency room were less likely to be assessed for their suicidal ideation (p<0.001). The working conditions of physicians, including ambulance caseload and midnight shift were not associated with the practice of suicide-risk assessment. Conclusion: Suicide risk assessment by front-line physicians in an emergency room was not sufficient, warranting further educational research on this issue. Knowledge and skills of front-line physicians are more influential in terms of their risk-assessment practice in comparison to their working conditions.