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KNOWLEDGE, ATTITUDES, AND PRACTICES OF EMERGENCY DEPARTMENT PROVIDERS IN THE CARE OF SUICIDAL PATIENTS
Author(s) -
Betz Marian E.,
Sullivan Ashley F.,
Manton Anne P.,
Espinola Janice A.,
Miller Ivan,
Camargo Carlos A.,
Boudreaux Edwin D.
Publication year - 2013
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22071
Subject(s) - medicine , interquartile range , emergency department , suicidal ideation , confidence interval , odds ratio , referral , staffing , family medicine , health care , suicide prevention , poison control , psychiatry , emergency medicine , nursing , economics , economic growth
Background We sought to examine the knowledge, attitudes, and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI). Methods Six hundred thirty‐one providers at eight EDs completed a voluntary, anonymous survey (79% response rate). Results The median participant age was 35 (interquartile range: 30–44) years and 57% of the participants were females. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81–91%) than in skills to assess risk severity (64–70%), counsel patients (46–56%), or create safety plans (23–40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6–20%) or that suicidal patient treatment was almost always a top ED priority (15‐21%). More nurses (37%, 95% confidence interval [CI] 31–42%) than physicians (7%, 95% CI 4–10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self‐confidence in skills, (odds ratio [OR] 1.60, 95% CI 1.17–2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95% CI 1.11–2.69) and 5+ postgraduate years of clinical experience (OR 2.06, 95% CI 1.03–4.13). Conclusions ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling, or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.