Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals.

Abstract

The safety of suicidal patients is expected to be maintained during hospitalization. This study surveyed a sample of adult inpatient psychiatric units in general hospitals across the United States about their use of various levels of supervision for suicidal patients, the advantages and disadvantages of these interventions, and issues of cost and reimbursement for the services. A 33-item questionnaire was sent to a nationwide random sample of hospital-based adult inpatient psychiatric units. A total of 105 surveys from all regions of the country were used in the analysis. Although 98 hospitals reported that they used one-to-one continuous observation of suicidal patients, observation of the suicidal patient every 15 minutes was the most frequently used type of supervision, ranked first or second in frequency by 69 hospitals. Patients' safety was the most frequently cited advantage of supervision, and increased staffing the most frequently cited disadvantage. In most cases, the cost of supervision for suicidal patients was absorbed by the hospital, and hospitals were not reimbursed for care based on the severity of patients' illness. Future research on the effectiveness of various strategies for supervision of suicidal patients should include cost-benefit analyses. Policies for reimbursement for care of suicidal patients should be based on the patient's severity of illness.