University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Suicide remains a public health issue and suicide care needs to be an integral part ofhealthcare delivery. In studies looking at medical system use patterns of people who die bysuicide, evidence demonstrates that these patients do indeed seek medical and or psychiatriccare in the year before their death. Specific to emergency department (ED) visits, researchstudies found that 7% of all patients who died by suicide were seen at an ED within a week oftheir death, while 14% were seen within a month, and 43.8% within the previous year. ZeroSuicide, a framework for suicide prevention, is based on the premise that there is no acceptablenumber of suicides, and that the healthcare industry needs to address this issue with evidence-based practices to achieve this goal. This project aimed to conduct a program evaluation of thecurrent state of Zero Suicide implementation of safety planning in the Atrium Health PsychiatricED at Behavioral Health-Charlotte using the CDC Model. Assessment methods included chartreview of high and moderate-risk patients seen in the ED over 3 months, evaluation ofeducational offerings and staff adherence, a survey of knowledge and attitudes of current staffregarding ZS and safety planning, and comparison of current versus ideal state of EMRutilization to promote safety planning in the ED. Using data collected from March 1 to May 31,2024, 457 ED adult patients screened as either high or moderate risk for suicide on the Columbia Suicide Severity Rating Scale (C-SSRS) were discharged from either the ED orObservation (OBS) units. Safety planning, using the Stanley-Brown Suicide Safety Planning tool,was conducted with 22.5% of these patients. Discharge location was closely correlated withwhether a patient received a safety plan, with OBS patients having received a safety plan in75% of cases in contrast to just 1.2% of ED discharges. Findings from policy review, staffevaluation (survey and meetings/shadowing), EMR review, and educational assessmentsindicated multiple gaps in implementation and identified opportunities for improved suicidecare in the ED.Doctor of Nursing Practic
