Each year in the United States, suicidal thoughts and behaviors lead to >15 million visits to emergency departments and stays in psychiatric inpatient units. We describe three key areas where advances are needed: (1) more accurate detection of patients at risk for suicide in hospital settings, (2) better use of time and resources with patients while in the hospital, and (3) identifying patients who are at the highest risk for suicide when their risk is at its highest. In this introduction to the special issue, we provide describe how the papers in this issue make needed advances regarding these three topics and outline directions for future suicide research in hospital settings.