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Objective: Emergency department (ED) visits for asthma are frequent and may indicate increased morbidity and poor primary care access. Our objective was to compare the effect of two interventions on [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2005.04.018 Byline: Arpi Doshi, Edwin D. Boudreaux, Nan Wang, Andrea J. Pelletier, Carlos A. Camargo Abstract: We describe the epidemiology of emergency department (ED) visits for attempted suicide and self-inflicted injury. Author Affiliation: From the University of Michigan Medical School, Ann Arbor, MI (Doshi); Departments of Emergency Medicine and Psychiatry, Cooper Hospital and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden, NJ (Boudreaux); and the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Doshi, Wang, Pelletier, Camargo) Article History: Received 3 November 2004; Revised 15 March 2005; Accepted 14 April 2005 Article Note: (footnote) Supervising editor: Arthur L. Kellermann, MD, MPH Author Contributions: AD, EDB, NW, AJP, and CAC conceived the study, planned the data analytic strategy, interpreted the results, and drafted/edited the manuscript. AJP and CAC conducted the data analyses. CAC takes responsibility for the paper as a whole. Funding and support: Dr. Camargo was supported, in part, by an EMF Center of Excellence Award (Dallas, TX) and Dr. Boudreaux by grant DA-16698 from the National Institutes of Health (Bethesda, MD).

Objectives: To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES). Design: Prospective [...]

Study objectives: The emergency department (ED) is an important focal point for asthmatic individuals with uncontrolled illness. Anecdotally, many adults presenting to the ED with acute asthma are active cigarette [...]

Byline: Edwin D. Boudreaux, Sunday Clark, Carlos A. Camargo Abstract: Study Objective: This study explored how a variety of demographic and illness-related factors were associated with telephone follow-up among patients visiting the emergency department for acute asthma. Methods: We performed a prospective cohort study as part of the Multicenter Airway Research Collaboration (MARC). The study was performed at 77 EDs in 22 US states and 4 Canadian provinces. ED patients, ages 2 to 54 years, who presented with acute asthma underwent a structured interview during their visit. Two weeks later, research personnel attempted to contact participants by telephone, using numbers obtained during the ED interview. Results: A total of 1,847 adult and 1,184 pediatric patients were interviewed in the ED. Of these, 1,308 (71%) adult patients and 1,026 (87%) pediatric patients were successfully reached for 2-week telephone follow-up. Multivariate analyses revealed the factor most strongly related to contact was age, with pediatric patients being 2.5 times more likely to be reached than adults (95% confidence interval 2.0 to 3.2). Also, participants who were black, low in socioeconomic status, lacking a primary care provider, and exposed to tobacco smoke were significantly less likely to have been reached (all P Author Affiliation: From the Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA.sup.*; the Department of Emergency Medicine, Massachusetts General Hospital,.sup.a and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,.sup.As. Boston, MA Article History: Received 16 August 1999; Revised 15 November 1999; Revised 25 January 2000; Accepted 8 February 2000 Article Note: (footnote) [star] Dr. Camargo is supported by grant No. HL-03533 from the National Institutes of Health (Bethesda, MD). The Multicenter Airway Research Collaboration is supported by grant HL-63253, and by unrestricted grants from Glaxo Wellcome Inc. (Research Triangle Park, NC) and Monaghan Medical Corporation (Syracuse, NY)., [star][star] Address for reprints: Edwin D. Boudreaux, PhD, Earl K. Long Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805-2498; 225-358-3940, fax 225-358-3939; E-mail eboudr@iamerica.net .

Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk–screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.

Validated secondary screeners are needed to stratify suicide risk among those with nonnegligible risk. This study tested the predictive utility of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) Secondary Screener (ESS), one of the screeners listed by The Joint Commission's Patient Safety Goal 15 resources as a potential secondary screener for acute care settings.

The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown.

Tobacco use is the leading cause of preventable disease and death in the USA. However, limited data exists regarding smoking cessation mobile app quality and intervention effectiveness. Innovative and scalable interventions are needed to further alleviate the public health implications of tobacco addiction. The proliferation of the smartphone and the advent of mobile phone health interventions have made treatment more accessible than ever. The purpose of this review was to examine the relation between published scientific literature and available commercial smartphone health apps for smoking cessation to identify the percentage of scientifically supported apps that were commercially available to consumers and to determine how many of the top commercially available apps for smoking cessation were supported by the published scientific literature. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, apps were reviewed in four phases: (1) identified apps from the scientific literature, (2) searched app stores for apps identified in the literature, (3) identified top apps available in leading app stores, and (4) determined which top apps available in stores had scientific support. Seven articles identified six apps with some level of scientific support, three (50%) were available in at least one app store. Conversely, among the top 50 apps suggested by each of the leading app stores, only two (4%) had any scientific support. While half of the scientifically vetted apps remain available to consumers, they are difficult to find among the many apps that are identified through app store searches.

Suicide remains the 10th leading cause of death in the United States. Many patients presenting to healthcare settings with suicide risk are not identified and their risk mitigated during routine care. Our aim is to describe the planned methodology for studying the implementation of the Zero Suicide framework, a systems-based model designed to improve suicide risk detection and treatment, within a large healthcare system.

Abstract.Background:Identification of factors that predict and protect against attempted suicide are critical for the development of effective suicide prevention and intervention programs. Aims:To examine whether substance use mediates the association between demographic characteristics, suicide attempt history, and reports of a suicide attempt within 12 months after screening positive for active suicidal ideation or behavior during the index emergency department (ED) visit. Method:Data were collected during the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Data collection included baseline interview; 6- and 12-month chart reviews; and 6-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Structural equation modeling was used. All pvalues were two-tailed, with p < .05 considered statistically significant. Results:Among the 874 subjects, 195 (22%) reported a suicide attempt within 12 months after the index ED visit. Of participants reporting a suicide attempt, 59% were < 40 years old, 59% female, and 76% non-Hispanic White. Associations between race, sex, and suicide attempt 12 months after the index ED visit may be mediated by a combination of alcohol misuse and cocaine use. Conclusion:Findings from the mediation analyses provide insight into the impact of substance use on future suicide attempts in various sociodemographic groups.

Mobile applications (apps) to improve health are proliferating, but before healthcare providers or organizations can recommend an app to the patients they serve, they need to be confident the app will be user-friendly and helpful for the target disease or behavior. This paper summarizes seven strategies for evaluating and selecting health-related apps: (1) Review the scientific literature, (2) Search app clearinghouse websites, (3) Search app stores, (4) Review app descriptions, user ratings, and reviews, (5) Conduct a social media query within professional and, if available, patient networks, (6) Pilot the apps, and (7) Elicit feedback from patients. The paper concludes with an illustrative case example. Because of the enormous range of quality among apps, strategies for evaluating them will be necessary for adoption to occur in a way that aligns with core values in healthcare, such as the Hippocratic principles of nonmaleficence and beneficence.

Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse.

The objective of this study was to test whether a brief educational/administrative intervention could increase tobacco counseling by emergency physicians (EPs). Pre-/post-study at eight emergency departments (EDs) with residency programs were carried out. EPs received a 1-hour lecture on the health effects of smoking and strategies to counsel patients. After the lecture, cards promoting a national smokers’ quitline were placed in EDs, to be distributed by providers. Providers completed pre-/ post-intervention questionnaires. Patients were interviewed pre-/post-intervention to assess provider behavior. Two hundred eighty-seven EPs were enrolled. Post-intervention, providers were more likely to consider tobacco counseling part of their role, and felt more confident in counseling. Data from 1168 patient interviews and chart reviews showed that, post-intervention, providers were more likely to ask patients about smoking, make a referral, and document smoking counseling. Post-intervention, 30% of smokers were given a Quitline referral card. An educational intervention improved ED-based tobacco interventions. Controlled trials are needed to establish these results’ durability.

Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine2007 Consensus Conference, “Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake,” convened a public health focus group. The question this group addressed was “What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?” Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population.

Objectives: To assess the prevalence, characteristics, and referral to health care of emergency department (ED) patients with elevated blood pressure (BP) and to compare those without a history of hypertension (HTN) with suboptimally controlled, known‐hypertensive patients.

Background:Limited information on antibiotic resistance of Streptococcus pneumoniae(SP) exists for patients discharged from emergency departments with community‐acquired pneumonia.

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Objectives:The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence‐based suggestions for clinical practice.

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Objectives:To examine factors associated with motivation to quit smoking and interest in an emergency department (ED)‐based intervention. Methods:Consecutive ED patients 18 years of age and older were interviewed. Severely ill and cognitively disabled patients were excluded. Smoking history, stage of change, self‐efficacy, presence of a smoking‐related illness, interest in an ED‐based smoking intervention, and screening/counseling by the patient's ED provider were assessed. Results:A total of 1,461 of 2,314 patients (64%) were interviewed. A total of 581 (40%) currently smoked, with 21% in precontemplation (no intention to quit), 43% in contemplation (intention to quit but not within the next 30 days), and 36% in preparation (intention to quit within the next 30 days). Approximately 50% indicated a willingness to remain 15 extra minutes in the ED to receive counseling. Only 8% received counseling by their ED provider. A regression analysis showed that greater readiness to change was associated with multiple lifetime quit attempts, presence of a quit attempt in the past 30 days, and higher self‐efficacy. Interest in an ED‐based intervention was more likely among patients who reported higher self‐efficacy. Conclusions:Approximately 50% of smokers reported at least moderate interest in an ED‐based intervention and a willingness to stay 15 extra minutes, but only 8% reported receiving counseling during their ED visit. Considering time and resource constraints, counseling/referral may be best suited for patients characterized by a strong desire to quit, multiple previous quit attempts, high self‐efficacy, a smoking‐related ED visit, and strong interest in ED‐based counseling.

Objectives:The authors sought to determine the 12‐month prevalence of depression among emergency department (ED) patients using a single‐question screen. Methods:This cross‐sectional study was conducted in four Boston‐area EDs. For two 24‐hour periods, consecutive patients aged 18 years or older were interviewed, excluding those who were severely ill, potential victims of sexual assault, or emotionally disturbed. During the interview, patients were asked “Have you had any of the following problems during the past 12 months?” Patients answered “yes” or “no” to a list of health problems that included depression. In a validation study, the authors found that this simple approach correlated well with results from the validated Center for Epidemiologic Studies Depression Scale. Results:Of 752 eligible patients, 539 (72%) were interviewed. Of these patients, 30% (95% confidence interval = 26% to 34%) reported depression within the past 12 months. Compared with their nondepressed counterparts, depressed patients were more likely middle‐aged, female, and of lower socioeconomic status. Depressed patients were more likely to be smokers and to report a diagnosis of asthma or arthritis/rheumatism. In a multivariate analysis, factors that were independently associated with depression were lower level of education, smoking, and self‐reported anxiety, chronic fatigue, and back problems. Conclusions:A 30% 12‐month prevalence of depression among ED patients was found. Depressed patients had a distinct sociodemographic and health profile. In the future, awareness of risk factors for depression in the ED setting and use of simple screening instruments could aid in the recognition of depression, with subsequent referral to mental health services.

Purpose. In this study, we examined the influence of self-efficacy in predicting stage of change (SOC) movement, without intervention, over a 1-month period for smoking cessation, exercise adoption, and dietary fat reduction.Design. The design of this study was longitudinal. Patients' stage of change and self-efficacy were assessed at baseline, and stage of change was reassessed at a 1-month follow-up. Patients were categorized as (1) Regressors (moved backward at least one stage), (2) Stables (no change), or (3) Progressors (moved forward at least one stage). Chi-square analyses were used to determine the ability of self-efficacy to predict stage movement at 1-month follow-up.Setting. The data were collected at a large, inner city, academic hospital in the southeastern United States. Patients were attending primary care clinics.Subjects. Five hundred fifty-four low income, predominantly African-American, individuals attending primary care clinics were participants in the study.Measures. Previously validated scales of stage of change and self-efficacy from Prochaska's laboratory were used in this study.Results. Results showed statistically significant differences between predicted andactual SOC movement for smoking cessation, exercise adoption, and dietary fat intake reduction. Baseline self-efficacy ratings were significantly related to stage progression, regression, and stability of stage of change for all three health behaviors. Thirty-seven percent of smokers who were predicted to progress on the basis of their self-efficacy scores progressed. For exercise adoption and dietary fat reduction, 50% and 44%, respectively, of individuals expected to progress at least one stage on the basis of self-efficacy scores progressed.Conclusion. Self-efficacy influences SOC movement for smoking cessation, dietary fat reduction, and exercise adoption.

Objectives:To explore the relationships between patient acuity, perceived and actual throughput times, and emergency department (ED) patient satisfaction. The authors hypothesized that high‐acuity patients would be the most satisfied with their throughput times, as well as the overall ED visit. The authors also expected overall ED satisfaction to be more strongly associated with perceived throughput times compared with actual throughput times, regardless of acuity. Methods:This was a prospective survey of 1,865 ED patients at a large, inner‐city hospital during a one‐month period. Data were collected on patient demographics, acuity of patient illness, actual waiting time for evaluation by a physician, and actual overall length of stay. Patient satisfaction with various throughput times (i.e., perceived throughput time) and overall ED visit was assessed by using a seven‐point scale (1 = poor, 7 = excellent). Analysis of variance, analysis of covariance (ANCOVA), and correlations were conducted to explore the hypotheses. Results:Patients with “emergent” acuity perceived their throughput times more favorably and were more satisfied with their overall ED visit compared with “urgent” and “routine” patients (all p < 0.01). Once the effects of perceived throughput time were controlled for by using an ANCOVA, acuity no longer predicted overall ED satisfaction. Correlations showed that overall ED satisfaction was more closely linked to perceived throughput times than to actual throughput times (average r= 0.62 vs. −0.12). Conclusions:“Emergent” patients are more satisfied than “urgent” and “routine” patients with their ED visits. “Emergent” patients perceived their throughput times more favorably than other patients, especially their wait for physician evaluation. Changing perceptions of throughput times may yield larger improvements in satisfaction than decreasing actual throughput times, regardless of patient acuity.

Objectives:The contradictory findings reported in the emergency department (ED) patient satisfaction literature may be due to methodologic differences between studies, as well as actual differences in predictors. The authors examined the stability of predictors of ED patient satisfaction across multiple assessments over 17 months. Methods:All patients who presented for emergency care to the authors' hospital during four designated time periods spanning 17 months were eligible. The participants were contacted by telephone and the following were assessed: demographics, visit characteristics, perceived waiting times, subjective quality of care indicators, and overall satisfaction. The authors computed logistic regressions to predict overall satisfaction for each of the four periods. They compared the results across the assessments, both visually and using an aggregated logistic regression, to determine the consistency of the final equations. Interpretations based on traditional p‐value cut‐offs and odds ratios (ORs) were compared. Results:When using a p‐value cut‐off strategy of p < 0.05, notable discrepancies in the predictors of overall satisfaction were common. Six indicators, including age, perceived wait before bed placement, perceived wait before physician evaluation, physician care, discharge instructions, and waiting time satisfaction, were statistically associated with satisfaction for only one of the four assessments. In contrast, examining the size of the ORs associated with each predictor showed far fewer discrepancies. Only physician care appeared to have large differences in the strength of its relation to overall satisfaction. This trend was confirmed by the aggregated logistic regression analysis. Conclusions:Using p‐value cut‐offs as the sole criterion for interpreting which variables are most important in determining ED patient satisfaction is ill‐advised, and may lead to spurious conclusions of discrepant findings. Nevertheless, some determinants of ED satisfaction likely differ meaningfully based on the cohort that is being examined. Overgeneralizing conclusions derived from a single ED patient satisfaction study should be avoided, especially those studies that are cross‐sectional and use a single site.

Purpose. The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise.Design. A cross-sectional design was used.Setting. The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas.Subjects. Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%).Measures. Standard questionnaires were given to assess stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction.Results. Although the χ2analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson χ2(df = 16) = 74.30, p< .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precon-templators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated.Conclusions. These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one.

Objective:Patient satisfaction is a commonly measured indicator of quality emergency care. However, the existing empirical literature on emergency department (ED) patient satisfaction provides little guidance on how to analyze, interpret, and use data obtained in the clinical setting. Using two EDs as examples, the authors describe practical strategies designed to identify priority areas for potential improvement. Methods:The authors used a cross‐sectional, observational design. All patients who presented for emergency care during the designated time periods were eligible. Patients were randomly selected, contacted by telephone, and surveyed using three measures of global satisfaction, 23 perceived quality‐of‐care indicators, and six perceived wait times. Descriptive statistics were calculated. Comparisons were made of each of the perceived care and wait time indicators against explicitly defined acceptability criteria to determine satisfiers/dissatisfiers. Each indicator was correlated with the three global satisfaction indices. The authors integrated results obtained from applying the acceptability criteria with those obtained from the correlations to yield priority indicators for remediation and maintenance strategies. Results:For hospitals A and B, respectively, 15 (52%) and 16 (55%) of perceived care and wait time indicators failed to meet acceptability criteria. Using the correlations with overall satisfaction, the authors further narrowed the priority areas for remediation to six indicators for hospital A and three indicators for hospital B. One maintenance indicator was revealed for hospital A and four for hospital B. Conclusions:A combination of applying explicit acceptability criteria to descriptive statistics and using correlation coefficients with overall satisfaction can help to maximize the usefulness of patient satisfaction data by uncovering priority areas. These priority areas were broken down into maintenance and remediation indicators and were found to vary considerably depending on the hospital in question. Such strategies can help to refine performance improvement efforts by targeting those domains with the greatest impact on overall satisfaction.

We investigated predictors of patient satisfaction in a large, municipal emergency department (ED). Patients were telephoned 10 days postvisit, and satisfaction was assessed using a structured survey with 22 items measuring several domains, as well as the estimated length of stay. The dependent variables consisted of ratings of overall satisfaction and likelihood of recommending the ED to others. Data were obtained from 437 (38.7%) patients. Univariate statistics revealed strong relations between indicators of perceived care and both dependent variables, with weaker and mixed findings pertaining to demographics and visit characteristics. The final logistic regression predicting overall satisfaction included the following items (P< .05): degree to which staff cared for the patient as a person, perceptions of safety, understandability of discharge instructions, nurse's technical skills, and satisfaction with wait for physician. Likelihood to recommend was associated with (P< .05): degree to which staff cared for the patient as a person, understandability of discharge instructions, perceptions of safety, age, and insurance status. Patients' perceptions of care, rather than demographics and visit characteristics, most consistently predicted satisfaction. However, differences were observed between the specific predictors for overall satisfaction and likelihood to recommend, providing a possible explanation for inconsistencies observed in the literature. (Am J Emerg Med 2000;18:394-400. Copyright © 2000 by W.B. Saunders Company)

•In this paper, we harmonized 4 of the most commonly used instruments for delirium identification—Confusion Assessment Method (long-form and short-form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (total and severity scores), and Memorial Delirium Assessment Scale.•Using modern methods in psychometrics, including item response theory, we aligned all of the instruments on the same metric, the propensity to delirium. After linking scores, we created a harmonized item bank, called the Delirium Item Bank (DEL-IB), consisting of 50 items that allowed for the creation of crosswalks, to allow scores to be translated across instruments.•Our results facilitate the comparison of studies, meta-analyses, and combining data sets.

Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide.

Statement of purposeTo identify care differences between those with and without alcohol intoxication among emergency department (ED) patients who screened positive for suicide risk.MethodsThis was a retrospective, observational study of electronic medical records at an urban ED with universal suicide risk screening. Eligible patients had screened positive (‘active suicide ideation’ or ‘suicide attempt within past 6 months’) between January 2014 and December 2015. We reviewed a random sample of charts from three a priori age groups (18–34 years, n=300; 35–59 years, n=300; and 60+years, n=200) for demographic, medical, and visit characteristics. The primary outcomes were evaluation by a mental health professional, provision of resources, and ED disposition.ResultsSuicidal individuals who were intoxicated (blood alcohol level >0 or other intoxication documentation) were more often males aged 35–59 years. Intoxicated, suicidal individuals were less likely than those who were not intoxicated to see a mental health professional during the ED visit (72% vs 84%, p<0.0001), or be admitted/transferred to a psychiatric or substance abuse facility (21% vs 30%, p-value<0.0001). Intoxicated individuals were more likely to be discharged home (68% vs 59%, p-value<0.0001) and receive referral resources (63% to 56%, p<0.0001).ConclusionThere were discrepancies in ED care between intoxicated and non-intoxicated patients. This may relate to patients who express suicidality while intoxicated and recant once sober, leading to a less thorough evaluation. It may also reflect difficulty engaging patients in mental health care while intoxicated.SignificanceAlcohol intoxication is a risk factor for suicide, yet it can complicate risk assessment by impairing patients’ judgement and thinking. While guidelines recommend suicidal ED patients receive a comprehensive risk assessment, this may not always occur. ED providers may need additional education or guidelines to enhance best practice for these cases.