The deadly consequences of delayed follow up are highlighted by Vaivas study of

The deadly consequences of delayed follow up are

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The deadly consequences of delayed follow-up are highlighted by Vaiva’s study of ED out-refer- rals. For the 605 patients enrolled in this randomized clinical trial, 48 attempted suicide before being contacted a month after the initial ED visit. 390 Motto’s study (Table 1), Cedereke’s study (Table 2), and now Vaiva’s study (Table 3) all report suicide attempts and suicide deaths as pos- sible unintended consequences of delayed interventions. 36, 378, 390 While none of these three studies were designed to prevent these deaths, the observational data provides a strong argument favoring continuity of care. Timing of the first intervention is most assuredly a key issue for continuity of care strategies and responsive public policy.
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Continuity of Care for Suicide Prevention and Research 74 See Table 3, Evidence-based Treatments for the Prevention of Suicide Attempts and the Enhance- ment of Continuity of Care, page 85. Possible benefit of giving high-risk patients a “crisis card:” “The Green Card Study” is the only randomized controlled trial found that considers the utility of “crisis cards.” 391 Each patient- participant in the population examined made his or her very first suicide attempt. The intervention was applied as soon as possible after admission, presumably to a hospital unit. A “green card” (“crisis card”) was given to each patient randomized to the experimental group. The “green card” described how to, at any time, contact a psychiatry resident; rehospitalization was also an option . The publication is silent about how well each patient knew his or her assigned resident. Follow-up data obtained after one year showed a significant reduction ( p ≤ 0.05) in the combination of actual or seriously threatened self-harm behaviors in the experimental group. There were seven actual at- tempts in the experimental group versus 15 in the controls. Statistical significance required inclu- sion of patients making serious threats of a repeat suicide attempt. A trend was noted ( p =0.053) towards lesser use of services in the experimental group. Of 212 patients recruited only 15 took advantage of the help made available by the “green card.” No information was obtained about the patients’ reactions to the experimental intervention. Surely, “crisis cards” may be practical, even effective, therapeutic tools. On these cards might ap- pear phone numbers of whom to contact during a worrisome episode of suicidal ideation. Gener- ally, these cards tend to be issued by a mental health professional that has had some prior contact with his or her client-patient. “The Green Card Study” delves into the utility of such cards. This is the only randomized controlled trial that this review identified that directly bears on this form of protection, which appears to have real merits. Here is means of connectedness showing someone cares and providing a way to call for help that is available day or night. The results from this study have stimulated the more wide-spread use of crisis cards in general safety planning.
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