ED-SAFE Suicide Screening Tool

The Joint Commission on Accreditation of Healthcare Organizations that accredits healthcare organizations in the US is often a requirement for state licensure or for receiving Medicare/Medicaid reimbursements.

One of the items in the Joint Commission accreditation is Goal 15.01.01, comprehensive suicide risk assessment. This involves screening of individuals who are at risk, and further assessment and intervention for those who have elevated risk.

There are three main types of screening:

1. Indicated Screening – Individuals who appear to be at risk based on demeanor or appearance are subjected to a suicide risk assessment
2. Selective Screening – Individuals who fall into certain high-risk categories (e.g. individuals with depression) are screened
3. Universal Screening – All individuals presenting to an organization (hospital, community organization, doctor) are given a brief suicide risk screening

While indicated screening is the most common currently practiced, neither indicated nor selective screening is sufficient to meet the Joint Commission requirements. In a study of 8 Emergency Departments who implemented universal screening, the rate of detected suicidal ideation was doubled. (Boudreaux, et al., 2015)

The ED-SAFE study involves a decision support tool that involves a series of structured questions to assess suicide risk.

Decision Support Tool

• Question 1. Ex. Have you had recent thoughts of killing yourself? Is there other evidence of suicidal thoughts, such as reports from family or friends?
• Question 2. Do you have any intention of killing yourself?
• Question 3. Have you ever tried to kill yourself?
• Question 4. Have you had treatment for mental health problems? Do you have a mental health issue that affects your ability to do things in life?
• Question 5. Have you had four or more (female) or five or more (male) drinks on one occasion in the past month or have you used drugs or medication for non-medical reasons in the past month? Has drinking or drug use been a problem for you?
• Question 6. Recently, have you been feeling very anxious or agitated? Have you been having conflicts or getting into fights? Is there direct evidence of irritability, agitation, or aggression?

If the patient answers yes to any of the above questions, a referral to a mental health clinician should be considered. For comprehensive suicide risk assessment beyond this tool, consider the SAFE-T Tool.

Caring for Adult Patients with Suicide Risk

The Suicide Prevention Resource Centre has developed this handy suicide risk guide to help you implement suicide risk assessment screening into your emergency department or community organization.

Bibliography

Boudreaux, E., Allen, M., Goldstein, A.B., Manton, A., Espinola, J., Miller, I. (2015) Improving Screening and Detection of Suicide Risk: Results from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) Effectiveness Trial. Society for Prevention Research 23rd Annual Meeting. Accessed Jun 28 2015 from https://spr.confex.com/spr/spr2015/webprogram/Paper23206.html