Compliance News: Risk of Suicides in Hospital ER and Inpatient Units

By Dean Samet, CHSP



The Joint Commission issued a Sentinel Event Alert in its warning of the increased number of reported non-psychiatric patients committing suicide in hospital emergency rooms/departments and medical/surgical inpatient units. Suicide has ranked in the top five most frequently reported events to The Joint Commission in the past 15 years and ranks number 11 by the Centers for Disease Control and Prevention (CDC) as a leading cause of death in the nation.


Typically, general or acute care hospitals’ emergency departments and med/surg units are not designed or assessed for suicide risks nor do they have staff with much, if any, specialized training to deal with suicidal patients. 


Some risk factors for such patients include: Dementia, traumatic brain injury, chronic or intense acute pain, poor prognosis and/or terminal diagnosis, and substance abuse. The location of suicide events has included bathrooms, showers, closets, and bedrooms as well as other locations. The methods of suicides have included strangulation via hanging, asphyxiation, gunshot, laceration, jumping from a height, drowning and drug overdose.


This Alert suggests that hospitals take a series of steps including:


•  Educate staff about suicide risk factors such as family history of suicide; anxiety and use of antidepressants; warning signs that may indicate imminent action; and how to be alert to changes in behaviors or routines.


•  Empower staff to call a mental health professional or resource person if changes in a patient are noted.  


•  Empower staff to take action, such as placing a patient under constant observation if the patient exhibits warning signs.


Existing TJC requirements on this subject are contained within the accreditation manual in the National Patient Safety goal chapter.  NPSG 15.01.01 states, “Identify patients at risk for suicide.  Note: This requirement applies only to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals.” While this NPSG may not specifically pertain to non-psychiatric patients in general or acute care hospital emergency departments or med/surg units, the below-listed EPs may be used in developing a program and training for hospital staff working in the EDs, ERs, or med/surg inpatient units.


Elements of Performance for NPSG.15.01.01


1. Conduct a risk assessment that identifies specific patient characteristics and environmental features that may increase or decrease the risk for suicide.



2. Address the patient’s immediate safety needs and most appropriate setting for treatment.


3. When a patient at risk for suicide leaves the care of the hospital, provide suicide prevention information (such as a crisis hotline) to the patient and his or her family. 



Hospitals are urged to take the necessary actions to prevent such tragic occurrences starting with conducting risk assessments that identify specific characteristics and environmental features that may increase the risk for suicide and to address appropriate safety needs.


Please review The Joint Commission’s Sentinel Event Alert Issue 46, November 17, 2010 in its entirety for more in-depth information covering: Risk factors for suicide; Contributing factors to suicide; Risk reduction strategies; and Joint Commission suggested actions. Also included is an extensive list of references and resources.


"Staff should be educated about suicide risk factors and empowered to take action.”