Wednesday, March 27, 2024

Safety Planning for Suicidal Patients in ED Linked to Lower Readmissions

Patients with suicidal behavior who received a safety plan—a set of suicide-prevention strategies—during an emergency department (ED) visit were less likely to be readmitted to the ED or the hospital for suicidal behavior or other mental health problems within 30 days of discharge than those who went to a hospital without routine safety planning. The finding appeared in a study published today in Psychiatric Services.

“Our findings support the notion of making safety planning universally available in EDs for patients with suicidal behavior and as a standard component of outpatient mental health care,” wrote Sara Wiesel Cullen, Ph.D., M.S.W., of the School of Social Policy and Practice at the University of Pennsylvania and colleagues.

Between May 2017 and January 2018, Cullen and colleagues mailed and emailed a survey about management of self-harm to a random selection of 665 hospitals that had recorded five or more ED episodes related to self-harm in the previous year. The contacted hospitals were linked with a patient population derived from a database of deidentified information on millions of individuals privately insured through UnitedHealthcare. The final sample included the 130 hospitals that had returned a completed survey and 2,328 patients who had continuous insurance eligibility 30 days before and after their ED visit.

The hospital survey included questions on how frequently EDs implemented the components of safety planning:

  • Helping patients recognize the warning signs of an impending suicidal crisis.
  • Providing strategies and identifying social activities to take patients’ mind off of their problems.
  • Identifying family members or friends whom patients could ask for help.
  • Providing a list of professionals or agencies to contact in a crisis.
  • Developing an individualized plan to restrict access to lethal means at home.

Possible responses were “never or rarely,” “sometimes,” “usually but not routinely,” and “on a routine basis.”

Of the 130 hospitals in the analysis, 55% routinely conducted safety planning. Of the patient sample, 62% visited EDs that routinely conducted safety planning.

Among patients who visited an ED that regularly provided a safety plan, 18% were readmitted to the ED and 12% were readmitted to the hospital within 30 days versus 22% and 15%, respectively, of patients who visited an ED that did not regularly provide safety planning. Among patients who had not received any mental health care in the 30 days prior to their ED visit, just 8% of those who went to an ED that routinely conducted safety planning were readmitted versus 14% of patients who were treated in an ED that did not routinely conduct safety planning.

“Safety planning may be more strongly associated with beneficial effects among individuals experiencing a new mental health crisis managed in the ED, perhaps by providing a clear roadmap of what to do when a crisis recurs and by teaching coping skills or strategies to help thwart subsequent crises,” the authors wrote.

For related information, see the Psychiatric News article “Emergency Department Intervention May Reduce Suicide Attempts in at-Risk Patients.”

(Image: Getty Images/iStock/pablohart)

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