Improving patient care after a suicide attempt

2018 ◽  
Vol 26 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Fiona Shand ◽  
Laura Vogl ◽  
Jo Robinson
Keyword(s):  
Suicide Attempt ◽  
Discharge Planning ◽  
Psychosocial Assessment ◽  
Coordinated Care ◽  
Effective Discharge ◽  
Effective Care ◽  
Increased Risk ◽  
Discharge From Hospital ◽  
Improving Patient Care ◽  
Risky Patients

Objectives: Improving the care that patients receive after a suicide attempt will reduce the risk of a subsequent suicide attempt. We described how care for these patients can be improved and identified the available guidelines. Methods: We reviewed the literature on crisis and aftercare, psychosocial assessment, risk assessment, brief contact interventions, and brief interventions. Results: People who have made a suicide attempt are at increased risk of suicide, and the period immediately after discharge from hospital is particularly risky. Patients require an empathic response at their first point of contact, comprehensive psychosocial assessment, effective discharge planning, rapid and assertive follow-up, and coordinated care in the subsequent months. Conclusions: Empathic and effective care that begins in the emergency department and extends through to community care is imperative. Enough is known about the risks of inadequate care and the key ingredients of effective care to proceed with changes to Australia’s healthcare response to a suicide attempt.

Discharge from hospital and early supported discharge

2020 ◽  
pp. 345-352
Author(s):  
Catherine Gaynor
Keyword(s):  
Discharge Planning ◽  
Models Of Care ◽  
Effective Discharge ◽  
The United Kingdom ◽  
Early Supported Discharge ◽  
Hospital To Home ◽  
Discharge From Hospital ◽  
Applied Health Research

‘Discharge from hospital and early supported discharge’ provides some useful guidance and outlines the issues that we encounter in facilitating effective discharge from hospital following a stroke. Hospital discharge is an important milestone in a stroke patient’s journey. It marks the end of the acute hospital episode, and the start of a new life living with and adjusting to their stroke and its sequelae. It can be a stressful time for patients and their carers, but careful and thorough discharge planning can help to ease the transition from hospital to home. The chapter explores the timing of discharge, models of care after discharge, early supported discharge, the evidence from SSNAP (Sentinel Stroke National Audit Programme) in the United Kingdom, the initiative of CLAHRC (Collaborative for Leadership in Applied Health Research and Care), guidance from the National Institute for Health and Care Excellence (NICE), institutionalization, role of capacity, role of IMCA (independent mental capacity advocate), communication with primary care, and follow-up after discharge from hospital.

Discharge planning for the patient with a new tracheostomy

1990 ◽  
Vol 10 (7) ◽  
pp. 73-79 ◽  
Author(s):  
EB Wilson ◽  
N Malley
Keyword(s):  
Critical Care ◽  
Planning Process ◽  
Discharge Planning ◽  
Signs And Symptoms ◽  
Critical Care Nurses ◽  
Care Plan ◽  
Discharge Care ◽  
Increased Risk ◽  
Hospital To Home ◽  
Discharge From Hospital

A patient with a new tracheostomy will face threatening changes upon discharge from hospital support. Nurses, particularly in the critical care unit, frequently and closely support a patient and family through new and often difficult situations during hospitalization. The patient leaving the hospital with a new tracheostomy will face problems with secretion management, increased risk of infections, alterations in body image, and impaired vocalization. To ensure a safe transition from the hospital to home, the patient and family must demonstrate competence in all aspects of tracheostomy care, must be able to recognize signs and symptoms that should be reported to the physician, and must have adequate support at home (such as homecare nurses, properly functioning equipment, and access to necessary supplies). These "musts" form the basis of the discharge care plan. Nurses can help a patient successfully manage these problems through comprehensive discharge planning. Although the critical care nurses who initiate the multidisciplinary discharge planning process may not remain involved in that process throughout the patient's hospitalization, their early efforts can provide an orderly, comprehensive discharge plan optimally suited to ensure that the patient and family acquire the necessary skills, confidence, supplies, and support for the eventual transition home. The information, encouragement, skills demonstrations, and referrals to other resources that critical care nurses provide help the patient adjust to a new tracheostomy.

Reassessment of Suicide Attempters at Home, Shortly After Discharge from Hospital

Crisis ◽  
2010 ◽  
Vol 31 (6) ◽  
pp. 303-310 ◽  
Author(s):  
Bas Verwey ◽  
Jeroen A. van Waarde ◽  
Molla A. Bozdağ ◽  
Iris van Rooij ◽  
Edwin de Beurs ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
General Hospital ◽  
Hospital Environment ◽  
Initial Assessment ◽  
Suicide Attempters ◽  
Systematic Assessment ◽  
Suicide Intent ◽  
Initial Hospital ◽  
Discharge From Hospital ◽  
At Home

Background: Assessment of suicide attempters in a general hospital may be influenced by the condition of the patient and the unfavorable circumstances of the hospital environment. Aims: To determine whether the results of a reassessment at home shortly after discharge from hospital differ from the initial assessment in the hospital. Methods: In this prospective study, systematic assessment of 52 suicide attempters in a general hospital was compared with reassessment at home, shortly after discharge. Results: Reassessments at home concerning suicide intent, motives for suicide attempt, and dimensions of psychopathology did not differ significantly from the initial hospital assessment. However, patients’ motives for the suicide attempt had changed to being less impulsive and more suicidal, worrying was significantly higher, and self-esteem was significantly lower. A third of the patients had forgotten their aftercare arrangements and most patients who initially felt no need for additional help had changed their mind at reassessment. Conclusions: Results from this group of suicide attempters suggest that a brief reassessment at home shortly after discharge from hospital should be considered.

Biochemical Markers in Patients with Readmission for Congestive Heart Failure

2018 ◽  
Vol 69 (7) ◽  
pp. 1687-1691
Author(s):  
Razan Al Namat ◽  
Mihai Constantin ◽  
Ionela Larisa Miftode ◽  
Andrei Manta ◽  
Antoniu Petris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Rural Areas ◽  
Discharge Planning ◽  
Difficult Problem ◽  
Uncontrolled Hypertension ◽  
Medical Attention ◽  
Family Doctors ◽  
Increased Risk ◽  
Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

2021 ◽  
pp. 216770262110250
Author(s):  
Mallory E. Stephenson ◽  
Sara Larsson Lönn ◽  
Jessica E. Salvatore ◽  
Jan Sundquist ◽  
Kenneth S. Kendler ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Suicide Attempt ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Sibling Pairs ◽  
Increased Risk ◽  
Using Data ◽  
Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

scholarly journals Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance: a mortality follow-back survey

2019 ◽  
Vol 48 (5) ◽  
pp. 680-687
Author(s):  
Anna E Bone ◽  
Catherine J Evans ◽  
Lesley A Henson ◽  
Wei Gao ◽  
Irene J Higginson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Health Professional ◽  
End Of Life ◽  
Respiratory Disease ◽  
Community Support ◽  
Free Text ◽  
Coordinated Care ◽  
Factors Associated ◽  
Increased Risk

Abstract Background frequent emergency department (ED) attendance at the end of life disrupts care continuity and contradicts most patients’ preference for home-based care. Objective to examine factors associated with frequent (≥3) end of life ED attendances among older people to identify opportunities to improve care. Methods pooled data from two mortality follow-back surveys in England. Respondents were family members of people aged ≥65 who died four to ten months previously. We used multivariable modified Poisson regression to examine illness, service and sociodemographic factors associated with ≥3 ED attendances, and directed content analysis to explore free-text responses. Results 688 respondents (responses from 42.0%); most were sons/daughters (60.5%). Mean age at death was 85 years. 36.5% had a primary diagnosis of cancer and 16.3% respiratory disease. 80/661 (12.1%) attended ED ≥3 times, accounting for 43% of all end of life attendances. From the multivariable model, respiratory disease (reference cancer) and ≥2 comorbidities (reference 0) were associated with frequent ED attendance (adjusted prevalence ratio 2.12, 95% CI 1.21–3.71 and 1.81, 1.07–3.06). Those with ≥7 community nursing contacts (reference 0 contacts) were more likely to frequently attend ED (2.65, 1.49–4.72), whereas those identifying a key health professional were less likely (0.58, 0.37–0.88). Analysis of free-text found inadequate community support, lack of coordinated care and untimely hospital discharge were key issues. Conclusions assigning a key health professional to older people at increased risk of frequent end of life ED attendance, e.g. those with respiratory disease and/or multiple comorbidities, may reduce ED attendances by improving care coordination.

scholarly journals Use of the Flugelman index for identifying patients who are difficult to discharge from the hospital

2013 ◽  
pp. 103-108
Author(s):  
Chiara Bozzano ◽  
Ilario Lancini ◽  
Elena Mei ◽  
Maida Lucarini ◽  
Roberta Mastriforti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Discharge Planning ◽  
District General Hospital ◽  
Feeding Problems ◽  
Care Needs ◽  
Socioeconomic Condition ◽  
Factors Affecting ◽  
Effective Discharge ◽  
Medical Wards

Introduction: To evaluate the use of multidimensional assessment based on the Fluegelman Index (FI) to identify internal medicine patients who are likely to be difficult to discharge from the hospital. Materials and methods: Have been evaluated all patients admitted to the medical wards of the District General Hospital of Arezzo from September 1 to October 31, 2007. We collected data on age, sex, socioeconomic condition, cause of admission, comorbidity score preadmission functional status (Barthel Index), incontinence, feeding problems, length of hospitalization, condition at discharge, and type of discharge. The FI cut off for difficult discharge was > 17. Results: Of the 413 patients (mean age 80 + 11.37 years; percentage of women, 56.1%) included in the study, 109 (26.39%) had Flugelman Index > 17. These patients were significantly older than the patients with lower FIs (85 + 9.35 vs 78 + 11.58 years, p < 0.001), more likely to be admitted for pneumonia (22% vs. 4.9% of those with lower FIs; p < 0,001). They also had more comorbidity, loss of autonomy, cognitive impairment, social frailty, and nursing care needs. The subgroup with FIs>17 had significantly higher in-hospital mortality (30.28% vs 6.25%, p < 0.001), longer hospital stay (13 vs. 10 days, p < 0.05), and higher rates of discharge to nursing homes. Conclusions: Evaluation of internal medicine patients with the Flugelman Index may be helpful for identifying more critical patients likely to require longer hospitalization and to detect factors affecting the hospital stay. This information can be useful for more effective discharge planning.

scholarly journals Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

2018 ◽  
Vol 214 (3) ◽  
pp. 146-152 ◽  
Author(s):  
Yuhui Wan ◽  
Ruoling Chen ◽  
Shuangshuang Ma ◽  
Danielle McFeeters ◽  
Ying Sun ◽  
...  
Keyword(s):  
Social Support ◽  
Gender Differences ◽  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Adverse Childhood Experiences ◽  
Interaction Effects ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Increased Risk ◽  
The Individual

BackgroundThere is little investigation on the interaction effects of adverse childhood experiences (ACEs) and social support on non-suicidal self-injury (NSSI), suicidal ideation and suicide attempt in community adolescent populations, or gender differences in these effects.AimsTo examine the individual and interaction effects of ACEs and social support on NSSI, suicidal ideation and suicide attempt in adolescents, and explore gender differences.MethodA school-based health survey was conducted in three provinces in China between 2013–2014. A total of 14 820 students aged 10–20 years completed standard questionnaires, to record details of ACEs, social support, NSSI, suicidal ideation and suicide attempt.ResultsOf included participants, 89.4% reported one or more category of ACEs. The 12-month prevalence of NSSI, suicidal ideation and suicide attempt was 26.1%, 17.5% and 4.4%, respectively; all were significantly associated with increased ACEs and lower social support. The multiple adjusted odds ratio of NSSI in low versus high social support was 2.27 (95% CI 1.85–2.67) for girls and 1.81 (95% CI 1.53–2.14) for boys, and their ratio (Ratio of two odds ratios, ROR) was 1.25 (P = 0.037). Girls with high ACEs scores (5–6) and moderate or low social support also had a higher risk of suicide attempt than boys (RORs: 2.34, 1.84 and 2.02, respectively; all P < 0.05).ConclusionsACEs and low social support are associated with increased risk of NSSI and suicidality in Chinese adolescents. Strategies to improve social support, particularly among female adolescents with a high number of ACEs, should be an integral component of targeted mental health interventions.Declaration of interestNone.

scholarly journals Mental disorders and risk of suicide attempt in prisoners

2020 ◽  
Author(s):  
Louis Favril
Keyword(s):  
Suicidal Ideation ◽  
Mental Disorders ◽  
Suicide Attempt ◽  
Prison Population ◽  
Total Sample ◽  
Epidemiological Studies ◽  
High Risk Population ◽  
Increased Risk ◽  
History Of ◽  
Mere Presence

Background: Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process—the transition from ideation to action—would provide valuable information for clinical risk assessment in this high-risk population. Methods: Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247). Results: One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73–4.13) and suicide attempt (OR range 1.82–4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR = 1.65, 95% CI 1.10-2.48), alcohol dependence (OR = 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR = 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators. Conclusion: Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

scholarly journals The effectiveness and safety of the use of antithrombotic therapy in COVID-19

2021 ◽  
Vol 18 (2) ◽  
pp. 17-30
Author(s):  
K. V. Lobastov ◽  
O. Ya. Porembskay ◽  
I. V. Schastlivtsev
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Increased Risk ◽  
Severe Infections ◽  
Thrombotic Complications ◽  
Risk Of Disease ◽  
Anticoagulant Prophylaxis ◽  
Discharge From Hospital ◽  
Outpatient Settings

The article is a non-systematic review of the literature, addressing the effectiveness, safety and appropriateness of antithrombotic drugs for COVID-19 in patients undergoing treatment in different settings: in the hospital phase, including the intensive care unit, in the outpatient phase after discharge from hospital, in primary outpatient treatment. The issues of thrombotic complications during vaccination and the necessity of their prevention are discussed. The studies confirm the importance of prophylactic doses of anticoagulants in all hospitalized patients. The use of increased doses has proven ineffective in patients with a severe course of the disease who are being treated in the intensive care unit. In moderately severe infections, there is a clear benefit of increased doses of anticoagulants in reducing the risk of organ failure, but definitive conclusions can only be drawn after the final results of the studies have been published. Prolonged pharmacological prophylaxis after hospital discharge may be useful in individual patients, but the overall risk of thrombotic complications in the long-term period does not appear to be high. The available data do not support the use of anticoagulants in the treatment of coronavirus disease in the outpatient settings, since the risk of thrombotic complications is not increased in such patients, and the safety of anticoagulant use has not been evaluated. Sulodexide may be useful in selected outpatients at increased risk of disease progression. Vaccination may provoke the development of atypical localized thrombosis by immune mechanisms, but the risk of such complications is lower in the coronavirus disease itself. Anticoagulant prophylaxis during vaccine administration is not indicated.

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