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Hospital Emergency Department Lethal Means Counseling for Suicidal Patients

  • Carol W. Runyan
    Correspondence
    Address correspondence to: Carol W. Runyan, MPH, PhD, Department of Epidemiology, Colorado School of Public Health, 13001 East 17th Place, Mailstop B119; Aurora CO 80045
    Affiliations
    Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado

    Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado
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  • Ashley Brooks-Russell
    Affiliations
    Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado

    Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado
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  • Gregory Tung
    Affiliations
    Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado

    Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, Aurora, Colorado
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  • Sara Brandspigel
    Affiliations
    Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado
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  • Marian E. Betz
    Affiliations
    Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado

    Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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  • Douglas K. Novins
    Affiliations
    Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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  • Robert Agans
    Affiliations
    Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Published:December 13, 2017DOI:https://doi.org/10.1016/j.amepre.2017.10.023

      Introduction

      Lethal means counseling of suicidal individuals in emergency departments has the potential to reduce suicide. This study examines the provision of lethal means counseling and the presence of written protocols in a region with high rates of both firearm ownership and suicide.

      Methods

      In 2015–2016, emergency department nurse managers in hospital-based emergency departments throughout eight states were surveyed using an 80-item survey developed through qualitative interviews and pilot testing. Questions focused on discharge counseling with suicidal patients and the presence of written protocols. Using survey weights to adjust for nonresponse, relationships of protocols with counseling practices were examined.

      Results

      Data were obtained from 52.3% of all 363 eligible hospital emergency departments in the region. Among facilities that discharge suicidal patients, 79.7% (95% CI=75.0%, 84.4%) reported asking about access to firearms and 68.9% (95% CI=62.9%, 74.8%) counsel about safe storage when patients reported access. Forty-four percent of emergency departments reported having written protocols for lethal means counseling. Presence of written protocols was associated with a higher rate of counseling for all suicidal patients even if they were not planning to use a gun (45.0% [95% CI=33.4%, 56.7%] in hospitals with protocols vs 21.5% [95% CI=14.9%, 29.0%] in facilities without protocols).

      Conclusions

      There are significant gaps in attention to lethal means counseling in emergency departments. This signals an opportunity to increase consistency and thoroughness of care for suicidal patients in the emergency department and for leadership from key professional organizations to advocate for protocols.
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