469 - Suicide Prevention Safety Plan Implementation at a Freestanding Children’s Hospital Emergency Department
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 469 Publication Number: 469.309
Stephanie Doupnik, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Adam Rudofker, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rachel Waimberg, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, United States; ANIK JHONSA, Childrens Hospital of Philadelphia, Moorestown, NJ, United States; Jason Lewis, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
Children's Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Suicide is the second leading cause of death among young people ages 10 to 24. Safety planning is an evidence-based intervention in which a clinician collaborates with a patient and family to create a structured plan for ongoing safety in the community after a patient leaves emergency department (ED) or inpatient care. Objective: At our quaternary freestanding children’s hospital, we aimed to increase safety plan completion for patients at risk of suicide discharged home from ED or inpatient medical care from 7% with a safety plan at project baseline to 50% at 18 months, regardless of patient gender, race, ethnicity, and insurance status. Design/Methods: We defined patients at risk of suicide as having a positive suicide screen and a subsequent elevated suicide risk assessment using the Columbia Suicide Severity Rating Scale, regardless of presenting chief complaint. An interdisciplinary team including members from psychiatry, psychology, emergency medicine, hospital medicine, social work, and informatics identified primary drivers of low safety plan completion rates, which included lack of clinician training and lack of a place to document a safety plan. The team then used PDSA cycles to sequentially implement: (1) electronic health record list of patients requiring safety plans (December 2021); (2) best-practice alerts to identify patients needing safety plans more accessible (January 2022); (3) Monthly reports to leaders of safety plan completion rates (February 2022); (4) hybrid virtual and in-person safety planning training including a safety planning simulation (July-December 2022). Results: During the project period, there were 2,217 encounters for patients at risk of suicide who were discharged home. Safety plan completion rates increased from 7% of patients receiving a safety plan by discharge at project baseline to 64% by December 2022, resulting in a centerline shift. Safety plan completion rates did not differ by gender, race, ethnicity, or insurance status. Electronic health record tools did not create in sustained improvements in safety planning rates without accompanying clinician training in safety planning. Safety planning training was completed by 68 of 70 eligible ED and inpatient-based social workers, psychologists, psychiatrists, psychiatric nurse practitioners, and trainees in those disciplines.
Conclusion(s): Our team implemented safety planning for more than half of ED and hospital discharges within our 18-month project period. Future directions include increasing ED safety planning rates, and implementing safety planning in primary care.
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