583 - Monitoring and Optimization Efforts of Universal Suicide Screening in the Pediatric Emergency Department

Suicide is the second leading cause of death in adolescents. The importance of suicide prevention prompted the Joint Commission to require health care systems to screen all patients greater than 12 years of age for suicidality upon arrival. Universal suicide screening in emergency department settings is feasible and widely accepted; however, there is a dearth of literature about maintenance and quality of universal suicide screening.

Objective:

The aims of this project were to assess the previously implemented universal suicide screening process and to improve the recognition and assessment of a positive suicide screen at an academic, tertiary referral children’s hospital emergency department (ED).

Design/Methods:

Each month the Columbia-Suicide Severity Rating Scale screened 81-94% of ED patients 12 years and older for suicidality.  Patients with non-psychiatric complaints and suicidal ideation (NPCSI) identified by universal screening served as a proxy to measure the success of the screening and assessment.  Suicidality would not have been addressed otherwise during these 20-51 monthly ED visits.  Chart review of these patients revealed that 50% of NPCSI patients had documentation of suicidality while only 33.3% had follow-up plans documented to address the suicidality. 

Process mapping identified a communication gap between the triage nurse performing the screen and the provider seeing the patient.  The electronic medical record created a alert in the patient’s chart after a positive suicide screen without any closed loop or direct communication.  A multidisciplinary committee of physicians and nursing explored a variety of solutions including immediate social work consult, direct notification of providers, and a physical flag at the patient’s door.  Due to inability to carry out these solutions, PDSA cycles relied on nursing and physician education. 

Results:

Initial PDSA cycles focused on nursing education and all provider education.  The final PDSA included monthly feedback emails to providers with missed NPCSI patients.  None of these interventions resulted in any significant or sustained improvement. (See figure.)

Conclusion(s):

If passive electronic medical record flags or banners are the expected notification system, EDs with multiple providers may miss early identification of suicidality and the opportunity for suicide prevention.  Education only strategies were not effective in improving provider recognition of positive suicide screens.  Further efforts are needed to maximize the opportunity to intervene early in adolescent patients with suicidality.