I Care Too: Preventing Suicide with the Help of Emergency Physicians

Mar 1, 2019 - In 2018, the American Foundation for Suicide Prevention (AFSP) forged a unique partnership with the American College of Emergency Physicians (ACEP) in an effort to reduce the number of suicides in the U.S., specifically by focusing on suicide prevention in emergency departments.

It is estimated that more than a third (39 percent) of people who die by suicide make a visit to the emergency department in the year prior to their death. Basic suicide prevention screening and interventions can therefore provide a safety net for at-risk patients seen in emergency departments. Emergency departments present a setting, and an opportunity, to save lives, and are one of the critical areas of AFSP’s Project 2025, which has the bold goal of reducing the U.S. suicide rate 20 percent by the year 2025.

To help achieve this goal, AFSP enlisted the help of ACEP in reaching emergency departments across the country. ACEP is the national medical specialty society representing more than 40,000 emergency medicine physicians and trainees across the U.S. Through its national staff and 53 chapters, ACEP is committed to advancing emergency care through continuing education, research and public education. By collaborating with key accrediting and professional organizations like ACEP, together we can find ways to hone the specific skills and actions in the ED setting that have been shown to reduce suicide risk, and improve the adoption of suicide screening and preventative intervention as best-practices in emergency care.

Among the biggest challenges to preventing suicide in emergency departments stems from the nature of the emergency department visit and the demands placed on emergency department staff. Think about the last time you visited an emergency department. There was probably a long wait – longer than you would have liked given your emergency situation – followed by a relatively short visit by the doctor, because there were probably many other patients, just like you, waiting patiently. When someone who may be experiencing suicidal ideation enters the emergency department – particularly if the ideation is secondary or perhaps not even related to the reason they are there – without having a quick and easy to follow procedure to assess for suicide risk, a physician or nurse may inadvertently miss those warning signs and a chance to support the person.

AFSP and ACEP set out to overcome this challenge by developing a rapid suicide screening and intervention tool for use by emergency physicians. ICAR²E (pronounced ‘I Care Too’), is a freely available, online tool for detecting suicide risk and providing risk-reducing care in the emergency department. The name is an acronym that stands for the key steps in the process:

Identify Suicide Risk

Communicate

Assess for Life Threats and Ensure Safety

Risk Assessment

Reduce the Risk

Extend Care Beyond the Emergency Department Visit

The ICAR²E tool was developed in the spirit of other rapid-use emergency department tools created by ACEP and utilized by emergency physicians. It is structured as a set of guidelines, based on the latest scientific evidence, with clear steps to take to help prevent suicide among patients. The tool also links to additional resources for emergency physicians to use, such as safety plan forms and follow-up materials. It is freely available online today, but the tool will also be made available as an interactive phone/tablet app in the future. We encourage all emergency physicians, nurses, and staff to explore and become familiar with the free ICAR²E tool, available now by visiting: https://www.acep.org/iCar2e

In addition to creating and sharing the ICAR²E tool, AFSP and ACEP set out to discover emergency departments across the country using their own innovative approaches to suicide prevention. Together, AFSP and ACEP launched a national award to identify “Innovations in Suicide Prevention in Acute Care.” Applicants from emergency departments and other acute care settings (e.g. urgent care) were encouraged to apply, with the goal of highlighting novel approaches that could be shared and replicated, ultimately improving care and saving lives across the country. The winners – who will be announced in the coming months – will be invited to present their program to AFSP and ACEP leadership, and will be featured on both organization’s websites. Further, AFSP and ACEP plan to open the award cycle again for new applicants later in 2019.

By focusing on suicide prevention in emergency departments, and through this tremendous collaboration with ACEP, we estimate that more than 1000 lives can be saved by 2025. Each day, with each use of the ICAR2E tool, and by learning about new approaches to suicide prevention in emergency departments across the country, we have the best chance to save lives and reach our bold goal by 2025.

For more information about Project 2025, including a link to the ICAR²E tool, click here.