Improving Suicide Risk Screening and Detection in the Emergency Department
Improving Suicide Risk Screening and Detection in the Emergency Department
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DOI：
10.1016/j.amepre.2015.09.029
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发表时间：
2016-04-01
影响因子：
5.5
通讯作者：
Miller, Ivan W.
中科院分区：
文献类型：
--
作者：
Boudreaux, Edwin D.;Camargo, Carlos A., Jr.;Miller, Ivan W.
简介：急诊科安全性评估和随访评估筛选结果评估检查是否普遍的自杀风险筛查是可行的，有效地提高自杀风险检测在急诊科（艾德）。方法：一个三阶段中断的时间序列设计：治疗作为药物（第一阶段），普遍筛查（第二阶段），普遍筛查+干预（第三阶段）。从2009年到2014年，来自7个州的8名ED参加了会议。数据收集跨越高峰时间和一周7天。如果病历中记录了故意自我伤害想法/行为的筛查（筛查），以及个人是否认可故意自我伤害想法/行为（检测），则确定病历审查。患者访谈确定记录的故意自我伤害是否为自杀。在第二阶段，在常规护理期间实施普遍自杀风险筛查。在第3阶段，进行了改进，以提高筛查率和保真度。计算卡方检验和广义估计方程。结果：在三个阶段（N= 236，791艾德访视记录）中，记录的筛查从26%（第1阶段）上升到84%（第3阶段）（卡方2 [2，n= 236，789]= 71，000，p < 0.001）。检出率从2.9%上升至5.7%（卡方（2）[2，n= 236，789]=902，p < 0.001）。大多数检测到的故意自我伤害被证实为最近的自杀意念或行为patient interview.Conclusions：通用的自杀风险筛查在艾德是可行的，并导致近两倍的风险检测增加。如果这些发现在规模上仍然正确，那么公共卫生影响可能是巨大的，因为识别风险是预防自杀的第一步也是必要的一步。(C)2016年美国预防医学杂志
Introduction: The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED).Methods: A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014.Results: Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (chi(2) [2, n=236,789]=71,000, p < 0.001). Detection rose from 2.9% to 5.7% (chi(2) [2, n=236,789]=902, p < 0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview.Conclusions: Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide. (C) 2016 American Journal of Preventive Medicine