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The recently published manuscript, Suicide attempts and completions
in the emergency department in Veterans Affairs Hospitals, makes several
recommendations to improve quality of care concerning emergency department
patients with suicidal ideation. These recommendations are excellent and
certainly will guard against untoward outcomes among VA patients who might
attempt suicide while in the emergency department.
At the VA Emergency Department New York Harbor Healthcare System we
have also implemented a team approach to safeguard patients' safety. This
approach consists of making "rounds" during the day when the emergency
department is busy with a team consisting of Charge Nurse, all staff
nurses, all physicians (in-training and attending physicians), nurse
technicians and social workers. During this time, the entire team reviews
each emergency department patient regarding presenting complaint, work-up
in progress, most likely disposition and safety concerns.
Thus, all patients are "introduced" to the entire team and issues
such as concerns for fall, suicide risks or possiblity of future social
service needs are reviewed. This team approach, I believe, will improve
outcomes for medical as well as psychiatric patients. If there are
emergency department patients with suicidal ideation, for example, not
only do they have "one to one" observation, but the entire team is aware
of this risk so that all healthcare providers cooperate to ensure the
safety of such patients.
I believe our innovative team approach for emergency department
patients will reduce the risk to patients with suicidal ideation. This
approach should be considered along with those recommended in "Suicide
attempts and completions in the emergency department in Veterans Affairs
Hospitals", to improve patient safety.
Nancy Lutwak, M.D.
Dept. of Emergency Medicine
VA New York Harbor Healthcare System,
NYU School of Medicine