Survey of the Management Systems and Decision-making Process of Emergency Medicine and Psychiatry for Patients Attempting Suicide

ABSTRACT

PURPOSE: Most patients attempting suicide present to the emergency department (ED). Active post-event intervention is helpful in preventing additional self harm. However, the current management system and decision-making processes of individual doctors are highly variable. This survey aimed to describe the ED management system and to compare the decisions of doctors in emergency medicine and psychiatry for patients for attempting suicide. METHODS: Questionnaires were sent by e-mail to directors of both ED and psychiatry departments in all Korean teaching hospitals. The questionnaires surveyed the current management system for suicidal patients in the ED, the medical director's opinion about the management of suicidal patients, and decisions about disposition of the three clinical scenarios. RESULTS: Sixty-four out of 180 surveys(36%) were returned. The average number of suicidal patients visiting the ED was 13.6 per month and the number referred to a psychiatrist was 11.3 per month. Half of EDs(15/30) had established criteria for patient disposition, but only 7% of ED and 82% of psychiatry departments had practice guidelines for doctors. Only 4% of ED performed any active post-event intervention other than psychiatry out-patient visits. Decisions of emergency physicians and psychiatrists about referring a patient to the psychiatrist in the three clinical scenarios were in part statistically different. CONCLUSION: This study suggests that appropriate facilities and standard guidelines for suicidal patients are needed. Each hospital should develop a common management protocol with collaboration between emergency medicine and psychiatry departments.