The Emergency Department (ER) is the first place of contact for individuals presenting with a suicidal crisis. In fact, studies show that individuals who die by suicide have visited the ER before. Psychiatrists who find themselves in the ER when faced with a patient with suicidal ideation or attempt have to decide the fate of these patients. This is a complex decision.
With this study, we aim to analyze the factors that influence the decision-making of psychiatrists at the Unidade Local do Alto Ave regarding the follow-up of patients in suicidal crisis.
In order to achieve this goal, all cases of suicidal ideation or attempt that came to the ER between January 2023 and December 2023 were analyzed. In these cases, the destination of these patients was verified, namely if they were hospitalized or discharged and, in the case of the latter scenario, what was the subsequent approach. By consulting the clinical file and the records kept by the psychiatrists, the reasons that led to this decision were verified. In addition, The Tool for Assessment of Suicide Risk (TARS) scale was applied to each case in order to compare the risk indicated by the scale and the decision taken.
It was found that psychiatrists' decision-making is based on their clinical assessment and the main risk factors identified in previous studies. When the decision was not to hospitalize the patient, they were referred to a psychiatry or psychology in one or two weeks. When we compared the application of the TARS scale, we saw that the decision based on the clinic was in line with the risk indicated by the scale.
In fact, decision making in an ER setting brings a number of challenges and is influenced by the patient, the context and the doctor. As the ER is a key place for suicide prevention, correct referral is essential. Scales and protocols have been developed to help in this decision-making process, but they are often difficult to apply in this context. Another factor to point out is that psychiatrists are often unaware of the long-term impact of their decision. It would be important to develop more training for psychiatrists working in the ER.