Clarity is important in health care. It is particularly important when the Centers for Medicare & Medicaid Services (CMS) is spelling out the “rules of the road” for hospitals to be able to participate in Medicare and Medicaid. Hospitals and their employees are dedicated to patient well-being and safety, but unfortunately, since 2016, hospitals have not had clarity about what is expected of them when it comes to keeping patients with suicidal ideation safe while under their care. 

In 2016, CMS urged The Joint Commission and state agencies to improve their assessments of the ligature risks for patients with suicidal ideations, but provided no written information on what CMS wanted hospitals to do differently. This led to hospitals being advised that they needed to eliminate ligature risks, what parts of the hospital had to be ligature free or how they were expected to do that at the same time they were providing treatment for the physical and mental disorders that brought the patient to the hospital in the first place. 

Last week, CMS published a memorandum to surveyors that takes a first step toward providing some clarity. Importantly, it distinguishes between specifically designated psychiatric units or hospitals and general acute care hospitals. CMS is focused on psychiatric hospitals and units where those who might be contemplating self-harm or harm to others are usually treated, and recognizes that other parts of general acute care hospitals that treat patients with a variety of disorders cannot be ligature free or ligature resistant and meet the wide variety of patient needs they must treat. The agency expects hospitals to take appropriate steps to mitigate the chance of harm when they have a patient who may be contemplating self-harm or harm to others. In contrast, CMS clarifies that hospitals and units designated expressly for the treatment of patients with psychiatric disorders are expected to be ligature resistant. 

For hospitals and those who work in these facilities, nothing is more important than the patients they serve each and every day. This means making sure they are safe from harm. We are glad that CMS has provided some clarity.  However, hospitals – and surveyors – need additional clarity around CMS’ expectations around ligature risk and other potential for harm and await the guidance CMS says will be published in six months.  

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