Psychiatric Emergency Services, Denver Health Medical Center, University of Colorado School of Medicine, Department of Psychiatry, Denver, CO. Electronic address: scott.simpson@dhha.org.
INTRODUCTION: Suicidal ideation and alcohol use are common among emergency department patients. It is unclear at what point a suicide risk assessment should occur among patients who present with acute alcohol intoxication. This study aims to describe practice patterns among expert practitioners for timing the suicide risk assessment for an intoxicated patient.
METHODS: An online survey was sent to emergency psychiatrists and behavioral health specialists on 2 national listserves including that of the Academy of Consultation-Liaison Psychiatry's Emergency Psychiatry Special Interest Group.
RESULTS: Sixty respondents had a mean of 16 ± 12 years (mean ± standard deviation) out of specialty training and had extensive experience and comfort in managing this patient presentation. All respondents were board-certified and most (68%) practiced in academic settings. The most common practice for conducting a safety risk assessment in alcohol intoxicated patients was to proceed once the patient was clinically sober (58%). Other practices included retesting the patient until a specific blood alcohol concentration was reached (19%) or waiting a certain time after presentation based on the initial blood alcohol concentration (15%). Some (8%) evaluated actively intoxicated patients for suicide risk. Practice varied slightly based on the location of practice, type of practice, and where the clinician trained.
DISCUSSION: Expert clinicians most often describe using a clinical assessment to determine sobriety before completing a suicidal risk assessment, although alternative practices remain common. While advantages and disadvantages vary among different approaches, the quality and evidence base underlying these practices are questioned.