ED suicide

[MGG1848]

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"Hospital cited in patient suicide"

http://www.ajc.com/metro/content/metro/stories/2008/02/24/ersuicide_0225.html

Its not uncommon for patients to wait 1-2 days in the ED for inpatient psych bed.

 

[southerndoc]

This is not unheard of. We also had a similar incident last year.

 

[bartleby]

Not terribly surprising given how long psych patients are boarding in EDs these days.

I had a schizophrenic in police custody (cop in room) in handcuffs, and under 1:1 observation (sitting in room) sit up, tear his bedsheet in half, wrap it around his neck, and start attempting to strangle himself. The best part was that the cop stood there with a horrified look on his face watching the guy do it for the 20 seconds it took me and the nurse to go into the room and start 4 pointing the guy.

 

[Dr. Dukes]

Not terribly surprising given how long psych patients are boarding in EDs these days.

I had a schizophrenic in police custody (cop in room) in handcuffs, and under 1:1 observation (sitting in room) sit up, tear his bedsheet in half, wrap it around his neck, and start attempting to strangle himself. The best part was that the cop stood there with a horrified look on his face watching the guy do it for the 20 seconds it took me and the nurse to go into the room and start 4 pointing the guy.

I would have thought the cop would have been all psyched to use his baton on the guy. When I'm working on the Ambulance some of the cops I know are all too excited to restrain people unnecessarily, and they don't often do it with a whole lot of courtesy.

 

[Jeff698]

At least the article made an attempt to point out this is a problem with overcrowding. All too often, the media will look for a scapegoat and not pay any attention to the underlying conditions leading to the event.

Take care,
Jeff

 

[Grace34]

If I wasn't crazy when I came, I'd be crazy after spending 22 hours in our county hospital's ED.

 

[Jeff698]

If I wasn't crazy when I came, I'd be crazy after spending 22 hours in our county hospital's ED.

I have a teenager in our department who has now been there for 63 hours! He's under an OED for suicidal ideation and, of course, has no insurance. We've been trying to find a bed for him for days.

Great system we have here.

Take care,
Jeff

 

[doctawife]

I have a teenager in our department who has now been there for 63 hours! He's under an OED for suicidal ideation and, of course, has no insurance. We've been trying to find a bed for him for days.

Great system we have here.

Take care,
Jeff

Isn't it great being a EM healthcare provider in Texas? I routinely have 12 year old patients with suicidal ideation who have to wait 48+ hours for a psych bed... in an ER with no shower, no privacy... nothing. We've got one option for those with minimal (ie county) funding and 6 options for everyone else. And all options are almost universally full all of the time.

I want to run away after a 12 hour shift - when I'm in a position of power! These poor kiddos with SI are just screwed six ways to Sunday. 24/7 sitter, dirty bathrooms, no shower, poor food. Yuck!

 

[USCDiver]

I once had a patient who was in the ED requesting Detox, he had been sober for something like 8 months and went out binging the night before. So of course he didn't meet any admission or detox criteria. When I initially took his history he wasn't having any SI. Before I could get him discharge to outpatient counseling he broke the glass on the "Our Number One Goal is Your Complete Satisfaction" plaque that's on the walls in all the rooms 🙂rolleyes🙂 and slashed his wrists.

 

[EMRaiden]

we had a patient stand in the hallway and try to choke himself with a glove,

 

[Jeff698]

Before I could get him discharge to outpatient counseling he broke the glass on the "Our Number One Goal is Your Complete Satisfaction" plaque that's on the walls in all the rooms 🙂rolleyes🙂 and slashed his wrists.

There's a poignant message in that somewhere.

Perhaps our endless worship at the altar of "customer satisfaction" is our way of slashing our collective wrists?

Take care,
Jeff <- a physician not a provider, caring for patients not customers or clients

 

[arctic187]

If you are at an ED that sees a lot of psych patients you unfortunately get complacent with the patient that comes in suicidal.

After seeing your 100'th overdose who states they took a bunch of pills and their level is 0, or the patient that comes in on a regular basis, its easy not to take people seriously. I also hate the nursing response to requesting a 1:1. But i have witnessed/heard of patients putting plastic bags over their heads, trying to inject air in their line, hanging from a belt with a knot thrown over a closed door, trying to set themselves on fire. Hello security??? isnt a lighter a bad thing to leave with the psych patient. Never mind the psych patient who pulls a knife 3 hours after being in the ed.

Not that orderng the 1:1 always helps. I have personally witnessed a man walk out of the bathroom (by himself) holding a BIG bottle of whisky who was on 1:1. Not sure how he hid it in his pants that whole time! It was strange he was becoming more and more drunk in the ED. He obviously got a little too drunk and forgot to hide it the last time!

 

[EM2BE]

Not that orderng the 1:1 always helps. I have personally witnessed a man walk out of the bathroom (by himself) holding a BIG bottle of whisky who was on 1:1. Not sure how he hid it in his pants that whole time! It was strange he was becoming more and more drunk in the ED. He obviously got a little too drunk and forgot to hide it the last time!

I needed that one right now

On another note, I've heard of pts using the "I have to go to the bathroom" to go through with actions (like suicide) that they never mentioned before going to the bathroom (therefore didn't know to watch out for them). I went to an ED one night for motivation to study and noticed each of their rooms had a toilet built into their cabinetry. Is this common other places? Do you think this would help prevent some of the problems with pts who "need to go to the bathroom"?

 

[a_ditchdoc]

It wasn't in the ED but I had one of my patients jump from a window while I was on my ICU rotation. What's even better, the guy already had one leg in a cast and was set to be released in about four hours. Luckily it was only 2-3stories, multilevel, so he could jump one story at a time.. As far as I know he didn't injure himself...of course, we never found him.

I learned a few good lessons:

1) People will lie to you with a straight face.
2) No matter how nice the patient is, or how rational sounding, do not release the restraints until they are discharged.
3) Crap rolls downhill.

It is all fun and games now, but when I got a page that said "Your patient in room XXX just jumped out his window", my heart did funny things and I felt immediately queazy. All I could think about was clicking on "D/C restraints" the night before.

If I ever see him again, I'll have to resist the urge to break his other leg.