719 - Suicide Prevention Best Practices in Pediatric Emergency Departments: A National Survey

Suicide attempt and ideation are increasingly common presenting complaints at freestanding children’s hospital emergency departments (EDs). The Joint Commission mandates for suicide screening but no national standards for other suicide prevention best practices such as discharge safety planning.


Objective:

To describe freestanding children’s hospital EDs’ use of suicide prevention best practices.


Design/Methods: We conducted a national, cross-sectional survey of the 53 US freestanding children’s hospital EDs in 2022 using email and follow-up phone calls and mailings. The survey queried use of 3 suicide prevention best practices recommended by the Zero Suicide Initiative: screening, risk assessment, and discharge safety planning. We described the findings using frequencies and percentages.

Results:

Directors of 41 freestanding children’s hospital EDs in 21 states completed the survey (response rate 77%). 21 EDs (51%) reported annual visit volumes between 50,000-99,000 and 11 (27%) reported 100,000 or more. Regarding the proportion of all visits that were for primary mental health complaints, 4 EDs (10%) reported 11-20%; 16 (39%) reported 5-10%; and 20 (49%) reported less than 5%. Most EDs reported using a structured instrument for suicide risk screening (n=38, 93%). Nurses were responsible for administering screens in most EDs (n=36, 88%), and the most common instrument used was the Ask Suicide-screening Questions (ASQ) (n=20, 49%). Nearly all EDs reported routinely assessing for past suicidal thoughts/behaviors (n= 39, 95%), for suicidal intent/plans (n=40, 98%), and for access to lethal means (n=36, 88%). The most common risk assessment instrument used was the Columbia Suicide Severity Rating Scale (CSSRS) (n=19, 46%). Structured discharge safety planning practices were used in most EDs (n=29, 71%), and most reported routinely offering strategies to make homes safer and reduce access to lethal means (n=30, 73%). Most EDs used local protocols, and a small number used evidence-based tools: Stanley & Brown’s Safety Planning Instrument (n=5, 12%) and Counseling on Access to Lethal Means (CALM) (n=4, 10%).


Conclusion(s):

US freestanding children’s hospital EDs report consistently using best practices for suicide screening and risk assessment. At least a quarter of EDs did not report routinely doing counseling on restricting access to lethal means or discharge safety planning. Discharge protocols for patients at risk of suicide represent an opportunity for future quality efforts.