title: Suicide attempts and completions in the emergency department in Veterans Affairs Hospitals.
abstract: BACKGROUND
  This is the first study of suicide attempts and completions in the emergency department (ED) in a large national medical system.
  
  
  METHODS
  All root cause analysis (RCA) reports completed of suicides and suicide attempts that occurred in ED in the Veterans Health Administration between 1 December 1999 and 31 December 2009 were reviewed. The method, location, anchor point for hanging and implement for cutting as well as the root causes were categorised.
  
  
  RESULTS
  Ten per cent of all RCA reports of suicides and suicide attempts that occur within the hospital occur in the ED. Hanging, cutting and strangulation were the most common methods. The most common anchor point for hanging was doors, and the most common implement for cutting was a razor blade. In eight of the 10 cases of cutting, the implement was brought into the ED. The most common root causes were problems communicating risk and being short-staffed.
  
  
  CONCLUSIONS
  Based on these results the following recommendations are made for helping to reduce suicide attempts in the ED: (1) use a systematic protocol and checklist to review mental health holding areas periodically in the ED for suicidal hazards; (2) develop and implement specialised protocols for suicidal patients that include continuous observation when possible; (3) conduct thorough contraband searches with suicidal patients; (4) designate specialised holding areas, when practically possible, for suicidal patients that are free of anchor points for hanging, sharps and medications, and medical equipment; and are isolated from exits to reduce the risk of elopement.
authors.affiliation: VA National Center for Patient Safety Field Office, White River Junction, Vermont, USA. peter.mills@va.gov
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
authors.forename: B Vince
authors.initials: BV
authors.lastname: Watts
authors.forename: Joseph M
authors.initials: JM
authors.lastname: DeRosier
authors.forename: Anne M
authors.initials: AM
authors.lastname: Tomolo
authors.forename: James P
authors.initials: JP
authors.lastname: Bagian
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D060891:Root Cause Analysis; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology