title: Knowledge, attitudes, and practices of emergency department providers in the care of suicidal patients.
abstract: BACKGROUND
  We sought to examine the knowledge, attitudes, and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI).
  
  
  METHODS
  Six hundred thirty-one providers at eight EDs completed a voluntary, anonymous survey (79% response rate).
  
  
  RESULTS
  The median participant age was 35 (interquartile range: 30-44) years and 57% of the participants were females. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81-91%) than in skills to assess risk severity (64-70%), counsel patients (46-56%), or create safety plans (23-40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6-20%) or that suicidal patient treatment was almost always a top ED priority (15-21%). More nurses (37%, 95% confidence interval [CI] 31-42%) than physicians (7%, 95% CI 4-10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self-confidence in skills, (odds ratio [OR] 1.60, 95% CI 1.17-2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95% CI 1.11-2.69) and 5+ postgraduate years of clinical experience (OR 2.06, 95% CI 1.03-4.13).
  
  
  CONCLUSIONS
  ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling, or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.
authors: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado.
authors: Marian E
authors: ME
authors: Betz
authors: Ashley F
authors: AF
authors: Sullivan
authors: Anne P
authors: AP
authors: Manton
authors: Janice A
authors: JA
authors: Espinola
authors: Ivan
authors: I
authors: Miller
authors: Carlos A
authors: CA
authors: Camargo
authors: Edwin D
authors: ED
authors: Boudreaux
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003625:Data Collection; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D010346:Patient Care Management; D010564:Personnel, Hospital; D012017:Referral and Consultation; D018570:Risk Assessment / Q000706:statistics & numerical data*; D059020:Suicidal Ideation; D000078329:Workforce; D000092864:Suicide Prevention
keywords: emergency medicine; healthcare provider; suicide