Predicting Death by Suicide Repetition

With existing data indicating that suicide attempt strongly predicts later death by suicide, researchers conducted a study to examine variables among ED patients seen for suicide attempt in order to investigate predictors of later confirmed death by suicide. Patients with a second ED visit due to suicide attempt were divided into those who died by suicide attempt and those who survived. Patients who consummated a suicide attempt were older, had middle socioeconomic status and lower global assessment of functioning (GAF) scores, wrote more wills, were less likely to have a history of major depressive disorder, have more self-inflicted illness or serious injury, and less interpersonal conflict or stress as precipitating factors for suicide. Significant predictors of death by suicide following multivariate logistic regression analyses were socioeconomic status, age older than 45, male gender, and GAF score at ED visit. Interpersonal conflict/stress was protective of death by suicide.

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Predicting Successful Psychiatric Observation Unit Discharge

Psychiatric observation unit use for patients presenting to the ED remains low in the United States, resulting in a relative lack of data regarding patient factors related to successful management in this environment. Data was assessed from 1,000 randomly selected ED patients who were admitted to Ohio State University’s psychiatric observation unit from 2014 to 2016 for a study. Observation care was deemed a success when the patient was discharged home and did not require inpatient psychiatric care. Patients aged 18 to 44 were most likely to be successfully discharged. Among patients with a Medicare plan, 57.3% were discharged home, compared with 70.6% of those on a managed care insurance plan. ED patients were most likely to be discharged home from the psychiatric observation unit if they presented on their own (71.4%) or by law enforcement (68.8%), when compared with those referred by other clinicians (48.6%).

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Residents’ Attitudes & Knowledge About OUD

Evidence suggests that even among medical professionals, opioid use disorder (OUD) is too often treated as a character flaw as opposed to a disease, leading to under-diagnosis and -treatment. Study investigators developed a 33-item survey to evaluate incoming emergency medicine (EM), internal medicine (IM), obstetrics and gynecology (OB), and psychiatry (Psy) residents’ knowledge and attitudes toward OUR during their first month of training. Scores were calculated for each participant based on correct answers to 13 knowledge questions. Preliminary results show that Psy residents had the highest average (75%), followed by IM (73%), OB (71%), and EM (60%). More than one-third (38%) of all residents reported receiving no formal training on OUD during medical school, and only 15% reported feeling knowledgeable about OUD treatment and resources in their community. Nearly half of all residents and nearly three-quarters of EM residents reported feeling unprepared to diagnose OUD. However, the vast majority (84%) of all participants reported a desire for more formal training in residency on OUD treatment.

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Physicians Have Highest Suicide Rate of Any Profession

High rates of suicide among physicians are well established, but how these rates compare with those of the general population are less well known. For a study, researchers conducted a systematic review of physician suicide-focused papers published in the previous decade. The team found that physicians have suicide rate of 28 to 40 per 100,000, more than double the rate of 12.3 per 100,000 in the general population. Although female physicians attempted suicide far less often than women in the general population, the completion rate for female physicians was 2.5 to 4.0 times higher and equal to that of male physicians. Poisoning and hanging were the most common means of physician suicide, with the findings suggesting that greater knowledge of, and easier access to lethal means, may play a role in the higher rate of suicide completions among physicians.

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Drug & Alcohol Testing in ED Psychiatry Patients

Illicit drug and alcohol exposure account for many ED visits in the US. While urine drug screens (UDS) and blood alcohol level tests (BAL) are frequently ordered in these cases, few studies have assessed the utility of these tests in diagnosis and management of ED psychiatry patients. For a study, UDS and BAL ordering and results, patient demographics, medical and psychiatric history, presenting diagnosis, treatment plan, and disposition were extracted and analyzed for ED patients with a mental health or addictions chief complaint. Among 323 patients, 60 received BAL and 92 received UDS, with main indications of “history of substance use” and “rule out substance-induced psychosis.” The management of only two patients (1%) was impacted by BAL and UDS testing, and more than one-third (35%) who received these tests did not receive addiction-specific treatment. The study authors suggest that increased education on the ordering of these tests could reduce unnecessary testing.

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EMR-Based Workflow for Involuntary Psychiatric Holds

Involuntary psychiatric holds (IPHs)—often used in EDs to detain dangerous and/or gravely disabled patients for the purpose of psychiatric hospitalization—generally require submission of an affidavit certifying the conditions of detainment. Despite the widespread use of electronic medical records (EMRs) in the US, submitting and managing affidavits for IPHs is often paper-based, potentially resulting in missing, incomplete, or illegible paperwork as well as staff and time inefficiencies. Researchers in California analyzed the implementation of an EMR-based version of an IPH (e5150) at their institution for a study. They compared e5150s written for patients presenting to the ED of an academic institution over 2 weeks following implementation of e5150 with paper-based IPH affidavits written during the 2 weeks prior to implementation. The primary endpoint was time between IPH initiation and availability of the IPH in the institution’s EMR. The mean time until availability for the e5150 was 1.9 hours, compared with 3.8 hours for paper-based IPH affidavits.

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Predicting Suicidal Behavior Recurrence

While research shows that suicide attempt is a risk factor for completed suicide, the relationship between suicide ideation and completed suicide remains unclear. To identify factors during an index episode of suicide behavior (SB)—suicide attempt and ideation—related to SB recurrence, researchers collected data on lifetime SB, sociodemographic and clinical parameters, and diagnostic category at an index SB episode among consecutive ED patients referred to an on-call psychiatrist  for suicide attempt or suicidal ideation between March and June 2015. During 12 months of follow-up, 70% of the cohort made 266 urgent consultations, 68 of which were SB episodes. One-third of participants were admitted to the ED with SB (53% attempts, 47% ideation), with 25% requiring hospitalization. SB recurrence occurred more often in those in contact with mental health services than those without linkage, whether before the index episode (39% vs 21%, respectively) or during follow-up (42% vs 9%). Urgent consultations due to other reasons were made by 76% of those with SB recurrence, compared with 55% of those without. No differences were observed based on age, gender, or previous SB profile.