Knowledge, confidence, guideline adherence and improvement needs regarding suicide prevention in acute care: a cross-sectional study in hospitals in the Netherlands

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BACKGROUND: Emergency departments (ED) and intensive care units (ICU) in general hospitals can contribute to preventive care for patients with suicidality. Despite the availability of guidelines worldwide, challenges remain in providing such care. In the Netherlands, it is unclear to what extent suicide prevention is implemented in acute hospital care. METHODS: Cross-sectional survey among ED and ICU professionals in 18 hospitals between 2020 and 2022. Primary outcomes were self-reported levels of knowledge and confidence in managing patients with suicidality. Secondary outcomes included self-reported familiarity with the national guideline and suicide prevention organisation, training uptake, guideline adherence, available institutional resources, and perceived needs to improve care. Using multivariable regression analysis, primary outcomes and guideline adherence were compared between healthcare professions, departments and hospitals. RESULTS: A total of 736 healthcare professionals (67% ED/33% ICU) participated. Reported knowledge and confidence were modest: 53% of ED staff and 42% of ICU staff scored ≥ 3 on knowledge, and 84% and 63% scored ≥ 3 on confidence (1–5 scale). Among ED and ICU staff, 85%/90% reported insufficient knowledge of the guideline, 42%/52% unfamiliarity with the national suicide prevention organization and 18%/29% had never participated in suicide prevention training or professional development. Mean guideline adherence scores were 3.5 (ED) and 3.6 (ICU); institutional resources scored 2.3 (ED) and 2.6 (ICU) (1–5 scale). Perceived needs included improved access to psychiatric review, expert consultation, training and education. Levels of knowledge and confidence were higher among ED staff and medical doctors compared to ICU staff and nurses. Guideline adherence varied markedly between hospitals. CONCLUSIONS: Despite the existence of a national guideline, Dutch EDs and ICUs face challenges in implementing comprehensive suicide prevention. Barriers exist at individual and organizational levels. A multi-level approach is needed, including staff training to improve knowledge, organisational commitment, and local protocols outlining essential steps and role clarity for acute care professionals. CLINICAL TRIAL NUMBER: Not applicable.

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