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Suicide Attempts and Alcohol Consumption

in an Emergency Room Sample

Guilherme Borges, Haydee Rosovsky

Objective: The aim of this study was to obtain an epidemiologic measure of association between

suicide attempts and alcohol consumption in eight emergency room (ER) hospitals. Method: Allpatients were interviewed and breath tested for alcohol consumption. The data were analyzed

using the case-control methodology. Cases were patients (N = 40; 21 male) admitted to ERbecause of a suicide attempt. The control group comprised patients (N = 372) admitted to ER

because of accidents that are less frequently reported as alcohol related (i.e., workplaceaccidents, animal bites, and recreational accidents, except drowning). Results: The proportion of

suicide attempts under the effects of alcohol was significantly higher than that of the controlgroup. The bivariate odds ratios (and 95% confidence intervals) for self-report of alcohol

consumption in the 6 hours prior to the suicide attempt were: abstainers (baseline); 0.001-100 gof alcohol = 2.01 (0.44,7.85); >100 g = 31.11 (10.13, 98.61). For habitual alcohol consumption:

abstainers (baseline); 0.001-100 g of alcohol = 0.67 (0.25, 1.77); >100 g = 1.10 (0.44, 2.75). ForAlco-Sensor: 9 mg of alcohol/100 ml of blood (baseline); 10-99 mg/100 ml = 8.21 (2.81,

23.73); 100 mg/100 ml = 2.97 (0.42, 15.95). Multiple logistic models did not change thesefindings. Conclusions: Alcohol consumption prior to the suicide attempt is a more important risk

factor than the habitual alcohol consumption pattern. New research should emphasize life eventsand psychiatric variables and find explanations for differences between the self-reported and the

Alco-Sensor estimates. (J. Stud. Alcohol 57: 543-548, 1996)

Background

Emergency departments are medical treatment facilities, designed to provide episodic care to

patients suffering from acute injuries and illnesses as well as patients who are experiencing

sporadic flare-ups of underlying chronic medical conditions which require immediate attention.Supply and demand for emergency department services varies across geographic regions andtime. Some persons do not rely on the service at all whereas; others use the service on repeated

occasions. Issues regarding increased wait times for services and crowding illustrate the need toinvestigate which factors are associated with increased frequency of emergency department

utilization. The evidence from this study can help inform policy makers on the appropriate mixof supply and demand targeted health care policies necessary to ensure that patients receive

appropriate health care delivery in an efficient and costeffective manner. The purpose of this

report is to assess those factors resulting in increased demand for emergency department servicesin Ontario. We assess how utilization rates vary according to the severity of patient presentationin the emergency department. We are specifically interested in the impact that access to primary

care physicians has on the demand for emergency department services. Additionally, we wish toinvestigate these trends using a series of novel regression models for count outcomes which have

yet to be employed in the domain of emergency medical research.

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Introduction

Emergency surgical admissions account for 46% to 57% of all surgical admissions [1-3] but

workload estimates are difficult to achieve because of the unpredictability and variability of such

admissions. There are no contemporaneous studies concerning the nature and volume of

emergency surgical admissions. The impact of the emergency surgical workload on surgicalpractice is not only determined by overall volume but also by patient demographics,appropriateness of referral, centralisation, diagnoses, and required surgical operations. [4] The

changing patterns have implications for surgical training, workforce planning and serviceprovision. [2] The Royal London Hospital, a multi-specialty inner city teaching hospital which

provides London's only Air Ambulance caters to a young, ethnically & socio-economicallydiverse, mainly immigrant population. [5] Health services in London are to be reconfigured, with

fewer centres catering to larger populations and this similar exercise is being carried out indifferent parts of the world for macro- and micro-economic reasons without adequate data on

volume, length of stay and problems for various specialties in hospitals. [6] This study sought toidentify the current patterns and common problems related to emergency room (ER) admissions

from a single hospital.

As patients can present at any time and with any complaint, a key part of the operation of anemergency department is the prioritization of cases based on clinical need. This is usuallyachieved though the application oftriage.

Triage is normally the first stage the patient passes through, and most emergency departments

have a dedicated area for this to take place, and may have staff dedicated to performing nothingbut a triage role. In most departments, this role is fulfilled by a nurse, although dependant on

training levels in the country and area, other health care professionals may perform the triagesorting, includingparamedics ordoctors.

Most patients will be assessed and then passed to another area of the department, or another area

of the hospital, with their waiting time determined by their clinical need. However, some patientsmay complete their treatment at the triage stage, for instance if the condition is very minor and

can be treated quickly, if only advice is required, or if the emergency department is not a suitablepoint of care for the patient. Conversely, patients with evidently serious conditions, such as

cardiac arrest, will bypass triage altogether and move straight to the appropriate part of thedepartment.

The resuscitation area is key in most departments and the most serious patients will be dealt within this area, and it contains the equipment and staff required for dealing with immediately life

threatening illnesses and injuries.

Patients whose condition is not immediately life threatening will be sent to an area suitable todeal with them, and these areas might typically be termed as a majors orminors area. Such

patients may still have been found to have significant problems, including fractures, dislocations,and lacerations requiring suturing.