465 - Improving Suicide Screening Rates in a Pediatric Emergency Department

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 465
Publication Number: 465.309

Skyler A. Tomko, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Kimberly Denicolo, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Presenting Author(s)

Jennifer A. Hoffmann, MD, MS (she/her/hers)

Assistant Professor of Pediatrics
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Background: Suicide is a leading cause of death among U.S. youth. Evidence-based suicide risk screening tools, such as the Ask-Suicide Screening Questions (ASQ), can detect youth at risk and prevent suicide. Numerous missed opportunities for suicide screening occur among youth who present to the emergency department (ED).

Objective: Our objective was to increase the percentage of patients 10 years and older presenting to our ED who receive suicide screening with the ASQ from 23% to 50% by November 2022.

Design/Methods: At an academic children’s hospital, a multidisciplinary team conducted a quality improvement initiative to improve suicide screening rates from January 2022 to November 2022. Identified barriers included limited time in triage and discomfort by nurses with administering screening. Sequential interventions included mandatory education sessions for ED nurses; printing reusable, laminated sheets with ASQ questions to enhance privacy in conducting screening; implementing a clinical pathway delineating standardized workflows for managing positive screens; and clinical decision support tools within the electronic health record to automatically notify physicians of positive screens and prompt orders for bedside sitters. We used run charts to measure monthly ASQ screening rates, overall and among patients with non-psychiatric chief complaints. As a secondary measure, we assessed the percentage of patients with positive ASQ screens who had a bedside sitter order placed.

Results: The percentage of patients 10 and older screened for suicide risk in the ED increased from a baseline of 23% to 53% by November 2022, with the greatest rise following mandatory education and printed ASQ tools (Figure 1). The percentage of patients 10 and older presenting with non-psychiatric chief complaints who received suicide screening increased from a baseline of 17% to 50%. Among patients with positive ASQ screens, placement of bedside sitter orders increased from a baseline of 2% to 21%, with the greatest rise following launch of the clinical pathway and clinical decision support tools.

Conclusion(s): A multifaceted intervention involving education, printed materials, a clinical pathway, and clinical decision support tools improved suicide risk screening rates in an academic children’s hospital ED. These strategies may be considered to optimize opportunities to prevent suicide among youth.