We don't use any specific tool for suicidal ideation at our hospital. If a patient comes into the ER and says they are suicidal, they are admitted to our ER Access Center. The Access Center is staffed with experienced psych RNs and social workers who do an assessment to determine the lethality of the pt's suicidal thoughts. Just because someone says they are suicidal doesn't necessarily mean they will be admitted. The following questions are all explored with the pt:
-Do they have a specific plan? Is the plan viable? The more specific the plan, the more details, the greater the lethality. Someone with a plan to jump off a bridge but without transportation to the bridge is probably ok. On the other hand, if someone is planing to shoot themselves and there is a gun in the house...much higher lethality.
-Have they put the plan in action? Have they started gathering any supplies they would need? Made arrangements to get loved ones out of the house? Buying pills, stockpiling pills, hiding a knife, buying bullets, figuring out train schedules, learning to tie a noose, searching the internet for ways to kill themselves, etc. are all very serious signs.
-Any history of self harm behavior, previous suicide attempts, or a family history of suicide? Any of these increase the chance that a person will take their life. The more serious and recent, the higher the lethality.
-What type of support do they have? If the pt is not admitted to the psych unit, do they have supportive friends or family they could call on if needed? Is someone available to stay with the pt, 24/7 in need be, until the pt can be seen by their psychiatrist or therapist? Someone without significant social support is more likely to take their life.
-What happened to cause the current crisis? Something acute - pt got fired today, wife just left, first grandbaby died unexpectedly - is more likely to warrant an admission to the unit.
-Finally, what does the pt think? Do they feel they would be safe if they left the hospital? Can they contract for safety if they leave, promising to return if they feel they can't be safe? How likely are they to follow up with their psychiatrist or therapist? In these crisis situations, most offices will see pts ASAP the following day.
The above assessment is used in the ER but it is also the same information we explore with the pt on a daily basis in 1:1.
Hope its helpful.