Carol W Runyan1, Ashley Brooks-Russell2, Gregory Tung3, Sara Brandspigel4, Marian E Betz5, Douglas K Novins6, Robert Agans7. 1. 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. Electronic address: carol.runyan@ucdenver.edu. 2. 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. 3. 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. 4. Program for Injury Prevention, Education, and Research, Colorado School of Public Health, University of Colorado, Aurora, Colorado. 5. 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. 6. Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado. 7. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Abstract
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.
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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