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Suicide attempts and completions in the emergency department in Veterans Affairs Hospitals
  1. Peter D Mills1,2,
  2. B Vince Watts1,2,3,
  3. Joseph M DeRosier4,
  4. Anne M Tomolo5,6,
  5. James P Bagian4,6
  1. 1VA National Center for Patient Safety Field Office, White River Junction, Vermont, USA
  2. 2Dartmouth Medical School, Hanover, New Hampshire, USA
  3. 3White River Junction VAMC, White River Junction, Vermont, USA
  4. 4VA National Center for Patient Safety, Ann Arbor, Michigan, USA
  5. 5Atlanta VA Medical Center, Atlanta, Georgia, USA
  6. 6Medical School and College of Engineering, University of Michigan, Michigan, USA
  1. Correspondence to Dr Peter D Mills, VAMC (10X), 215 N. Main Street, White River Junction, VT 05009, USA; peter.mills{at}


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.

  • Mental health
  • self-harm

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  • The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the US government.

  • Funding This material is the result of work supported with resources and the use of facilities at the Department of Veterans Affairs National Center for Patient Safety at Ann Arbor, Michigan, and the Veterans Affairs Medical Centers, White River Junction, Vermont.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Research and Development Committee, VAMC White River Junction VT, USA, and the Committee for the Protection of Human Subjects, Dartmouth College, considered this project exempt.

  • Provenance and peer review Not commissioned; externally peer reviewed.