The Frontier Psychiatrists is a health-themed newsletter. Owen Muir, M.D. writes it. Today, a quick reflection on the importance of measurement.
I'm really nerdy. I like regulatory updates. I get very excited about them. Today, I'm excited to let you know that as of 2024, The Joint Commission has decided that patient suicide is a sentinel event.
A Sentinel Event
…is defined as follows:
A sentinel event is a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that reaches a patient and results in any of the following:
– Death
– Permanent harm
– Severe temporary harm and intervention required to sustain life
A death by suicide will now be considered a sentinel event if it happens either within a healthcare setting, within seven days of discharge from an inpatient setting, from an emergency department, or within seven days from discharge from intensive outpatient treatment, residential settings, group homes, or transitional supportive living.
The current standard has only considered the sentinel events within 72 hours. Sentinel events get measured. They get counted. Things that are counted can be understood, can be tracked, can be followed, and can be acted upon. I've written before about how the highest time for completed suicide is the two weeks after discharge, from inpatient, and this does an important part of the lift in terms of making follow-up after discharge. Something… that we all have to take seriously.
This is also going to be a huge pain in the neck for individuals working in those settings, because more suicides will be a big deal. This is just and reasonable. None of us took the suicides of our patients lightly. These are emotionally laden events.
However, making it something we have to follow up on, something we have to report on, and some hospitals are graded on, and audited for brings an entire new level of seriousness to post-discharge suicide and its follow up.
Honestly, I hope the numbers are as sobering as I fear they will be. And I hope they push us towards more effective treatments, like SAINT neuromodulation, Esketamine, and other rapid-acting therapeutics.
Let’s get serious about suicide as a sentinel event—now, it’s mandatory…for up to a week.
Suicide among teen girls is the highest it's ever been, especially since 2009 with the iphone's front-facing camera selfie mode, combined with the cyber-bullying like button, which also came out that year:
https://romanshapoval.substack.com/p/how-does-emf-affect-children
It is an important event, and it should be taken seriously. I think a more effective approach to this problem would be to require insurance companies to pay for adequate time in the hospital, and adequate aftercare; this will penalize hospitals for systems issues. Every time I go to my doctor and a bored medical assistant, typing into the computer, asks me if I have thought of suicide in the past month, I mentally raise a glass to all the ways that JCAHO requires compliance in ways that will never be effective.