Checking off hazards: Physical changes to patient surroundings may reduce suicide rates
For years, facilities operated by the Department of Veteran’s Affairs have seen an epidemic of inpatient suicides. Over the last decade, an initiative taken to address suicide risks in patients’ physical environments has done a great deal to curtail that danger.
The VA is leading the way for civilian facilities in many different ways and I commend them for doing so. I hope the new commander-in-chief will keep up the good work—I am optimistic. Patient safety starts with excellent leadership—that means from the very top.
Introduced in 2007, an “environmental checklist” was meant to help secure safer surroundings for those veterans placed in inpatient care to help curb the persistent suicide epidemic. The “checklist” has 114 items for VA hospitals and inpatient centers to tick off when identifying environmental risks that would pose opportunities for an attempt to complete a suicide. Items such as hooks, clothing rods in closets, door knobs and electrical sockets can be more than part of standard furnishing in a patients’ room; they can pose a deadly opportunity for veterans already at risk to act on ideations. If the patient is psychotic, the patient must be observed line of sight or one to one. If not the patient can stuff food, clothing, toilet paper, or anything down his or her throat.
Thankfully, more than 150 VA hospitals have sought to implement the checklist; installing shelving and cubbies that lack sharp edges, removing hooks from walls and backs of doors, and moving towards making electrical outlets tamper proof. Eliminating these physical hazards takes stress off of hospital staff and allows them to focus on direct patient care; checking on the patients more frequently and receiving more elaborate training on how to identify, care for, and report patients at a risk for suicide. With the high turnover of staff and without the physical change of the patients’ environment, some precautions might be overlooked. Dr. Vince Watts, leader of a study on the checklist, commented that “hardwiring” changes into the facilities means that new or rotating staff couldn’t be forgetful regarding modifications.
Thankfully, the program seems to have had some success. During the duration of Dr. Watt’s study, the average length of stay in VA mental health facilities dropped from 11 days to around 7 days.
Has this method made a significant impact on veteran suicides?
While completed suicides among veterans remain far too prevalent in our society, the evidence shows that this is beginning to change. Prior to the checklist being implemented, the National Center for Patient Safety’s database reported a rate of 4.2 suicides per 100,000 admissions. Without such precautionary measures such as the checklist system in place, every patient could be one step away from taking their life. After the checklist was put into place, the suicide rate plummeted to 0.74 suicides per 100,000 admissions, showing that there is hope for the mental health care that our veterans deserve after their dedicated service. However environment of care is just one part of the triad to protect patients: the other two parts are proper observation levels and medication.
The risk of suicide for veterans is currently 21% higher than the civilian population, but preventative measures are steadily helping to decrease that number. Crisis lines are actively hiring new responders and putting them through extensive training to properly handle the calls and issues they will face, measures to identify high risk veterans are being taken so a crisis can be stopped before it even takes place.
The VA’s example shows that something as seemingly trivial as a checklist for inpatient facilities to follow can save lives, and civilian hospitals ought to follow suit. By removing physical dangers from a patients’ presence and replacing them with more continuous, educated and accessible care, we can hope to see more lives continue and zero end too soon.