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Q & A : Suicide Risk Assessment in the ED, Part 1

Emergency Management Alert, August 28, 2007

The Joint Commission's inclusion of suicide-risk assessment as a 2007 National Patient Safety Goal (NPSG) and its subsequent enactment of suicide prevention as a program-specific tracer has prompted questions from those in emergency care wondering how the NPSGs may apply to situations within the ED. Here is the first of a three-part series featuring questions from ED staff.

Q: Our ED sees patients with suicidal ideation in addition to regular medical patients, and I'm trying to determine standard of care for the ED. Once a physician, having determined the patient has suicidal ideation, places a sitter with the patient, is the patient allowed to use the restroom without direct observation? Does the door need to be slightly ajar, or is the patient required to use a bedpan?

A: An actively suicidal patient should be monitored at all times. Having a sitter in the room while the patient uses the restoom with the door ajar whould be sufficient. For someone who has actively continued to attempt self-harm while in the ED, "touching distance" monitoring may be indicated.

Source: Suicide Risk Assessment: Practical Strategies and Tools for Joint Commission Compliance, by Lauren R. Ball, MSW, LCSW, BCD, a guide for non-psychiatric hospitals.

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