ED-SAFE Patient Safety Screener 3 (PSS-3)

PSS-3 Calculator

1. Over the past 2 weeks, have you wished you were dead or wished you could go to sleep and not wake up?

2. Over the past 2 weeks, have you actually had any thoughts of killing yourself?

3. In your lifetime, have you ever attempted to kill yourself?

PSS-3 Score: –

Score: 0

Default scoring assumes 0 for un-set responses.

Screens for suicidality in emergency patients.

Why Use

3-12% of ED patients presenting with non-psychiatric chief complaints actually have suicidal ideation ( Boudreaux 2013 ). Identifying these at-risk patients is an important first step in implementing an intervention to prevent death/sequelae from suicidal behavior. Traditional suicide risk measures are lengthy and complex. ED-SAFE PSS-3 is a short, efficient screener that can be easily integrated into the existing ED clinical workflow.

When to Use

Emergency patients presenting for any complaint, even non-psychiatric complaints, to screen for suicide risk.

Formula

Positive screen = selection of “Yes” to question 2 or 3 below: Variable Ask the patient: 1. Depressed mood “Over the past two weeks, have you felt down, depressed, or hopeless?” No Yes Refused 2. Active suicidal ideation “Over the past two weeks, have you had thoughts of killing yourself?” No Yes Refused 3. Lifetime suicide attempt “In your lifetime, have you ever attempted to kill yourself?” No Yes Refused 3a. Recent suicide attempt (if it happened within the last 6 months) “When did your last attempt occur?” (only ask if yes to question 3) Today Within 30 days Within 1-6 months >6 months Does not know Refused

Pearls / Pitfalls

Dependent on the patient’s ability to answer the question; thus, it cannot be used in patients who cannot engage in conversation (e.g. if intubated or with altered mental status). Has strong agreement with well-established but lengthier suicide risk assessments like the Beck Scale for Suicide Ideation (BSSI).

Management

The ED-SAFE PSS-3 is a screen and not an endpoint. A positive screen should prompt provider to delve deeper in assessing the patient for suicidality and to consider consulting a mental health professional for the patient. More in-depth screens or assessments for suicide risk include the Beck Scale for Suicide Ideation (BSSI) and Columbia Suicide Rating Scale (C-SSRS) . Patients for whom providers have high concern for suicidality should be assessed by a mental health specialist.

Critical Actions

The ED-SAFE PSS-3 is meant to be a universal screening tool. Patients presenting to the ED, regardless of whether the primary complaint is psychiatric or not, can be screened with this universal screening tool.

Advice

Patients screening positive should be further assessed by the treating physician to determine if a mental health professional should be consulted. A safety plan may also be considered.