Research Summary of "Suicide Risk in the Emergency Department"
Sue Hoppler RN
Grand Canyon University
The review of the research article “Suicide Risk Screening in an Emergency Department” by
Victoria N. Folse and Rebecca L Hahn offered. Administering a four-question suicide risk questionnaire to 202 patients presenting to an emergency department was used attained the information on the benefit of this assessment. The participant sample included 59 adolescents and 143 adults including 36 geriatric patients. The patients were given the questionnaire regardless of their initial complaint. Over 40% of the patients screened positive as a suicide risk. The greatest benefit concluded that nurse screening for suicide risk is an important and beneficial part of the admission process. Suicide is the 11th leading cause of death in Americans and 3rd cause of death for adolescents. The rates of patient over the age of 65 are increasing especially over the age of 85. Patients that present to the Emergency Department often have no primary care provider and use the emergency department for their health care needs. This presents the optimal opportunity to screen for suicide risk at every age level. Patients at risk often go undetected and unrecognized and therefore untreated. Even patients that present to the ED for non- suicidal or mental health reasons had positive screening results.
The RSQ (Risk of Suicide Questionnaire) was initially tested in a pediatric facility and consisted of 14 questions. This proved to be too long and was the condensed to 4 questions and tested in a Level I trauma Center Emergency Department in the Midwest. This studies had results of 30% of ED patients had a positive suicide risk assessment. These patients were screened regardless of complaint or diagnosis. Patients that presented to the emergency department with suicidal complaints were not screened. The purpose of this study was to determine the accuracy of administering the 4 questions RSQ to a varied population of adolescents and adults to determine suicide risk. The RSQ was administrated by emergency department RN’s trained by the research team. The questions that guided this study consisted of:
1. How reliable is the RSQ in adolescent and adult patients in the ED?
2. Does the RSQ demonstrate adequate criterion related validity in a sample of adolescents and adults seeking treatment in an ED?
3.Does the suicide risk detect suicide risk in the ED individuals with and without chief complaints involving suicide? The method used to measure suicide risk was the 4 question RSQ developed by Horowitz et. El. (2001) The questions administered to all participants: 1. Are you here because you tried to hurt yourself? 2. In the past week, have you had thoughts about killing yourself? 3. Have you ever tried to hurt yourself in the past? 4. Has something very stressful happened to you in the past few weeks? The answers were recorded yes or no and confidentiality was assured by using medical record numbers. The discharge diagnosis was also recorded for future correlation. The procedure started with informed consent obtained on all participants. All participants were given the option of privacy for questioning. Registered nurses working in emergency department volunteered to assist in research study. They were trained on how to administer the RSQ questionnaire to ensure consistency. Participants completed an informed consent. The information was collected over 21 days, on all shifts by trained personnel. The process took about 90 seconds with each patient. If one or more of the questions resulted in a positive response, several follow up questions were asked. The evaluator would then determine the risk and the physician were notified. The patient was then treated according to hospital policy, which included referral, admission or discharge with non-suicidal diagnosis. The results of the study showed a disproportion in the number of yes answers especially in question 4, which did not result in suicide related risk. Questions 1 and 2 were the strongest indicators of suicide risk. Questions 3 and 4 proved to be unreliable. Correlation was done by comparing patients that answered yes on the RSQ to their chief complaint and their suicide, mental health related diagnosis. There was a large correlation between question 1 and 2 with discharge diagnosis. A question 3 correlation was low and a question 4 correlation was not significant. The results showed 41.6% of the total participants had a positive RSQ only 1.5% were actively suicidal. The rational for this result may be due to the fact that no actively suicidal patients that presented to ED were included in this project. The conclusion of these results indicated that even thought the reliability of this test is questionable; this is an easy to use assessment that can be a rapid and reliable tool. This can be done by non-mental health RN’s. It may be necessary adjust the questions of the RSQ to be more specific to current suicide risk. There are a significant number of patients at some risk for suicide and the emergency department is an optimal opportunity for assessment. The study does indicate it may not be beneficial to screen all patients but there is a significant population where it is beneficial.
