688 - Screening and Managing Adolescent Suicide Risk in Pediatric Primary Care: A Quality Improvement Collaborative Approach

Suicide was the second leading cause of death among U.S. youth aged 10-17 in 2020, a crisis further exacerbated by the COVID-19 pandemic. According to death registry studies, approximately 75% of suicide decedents visited a health care provider in the year before their death, compared to only one third who visited a mental health provider. To identify youth at risk and prevent suicide, the American Academy of Pediatrics recommends annual suicide risk screening during pediatric primary care visits as part of its periodicity schedule.

Objective:

To increase suicide risk screening compliance by 25% during an 18-month quality improvement project (QIP) within a pediatric primary care network. Secondary aims were to improve provider comfort in screening for and managing suicide risk.

Design/Methods: A 28-practice primary care network, Quality Through Technology and Innovation in Pediatrics (QTIP- housed at the South Carolina Department of Health and Human Services), implemented suicide risk screening. Participating practices completed 10 monthly chart audits documenting whether suicide risk screening was conducted, as well as the screening results and care plan. Participants were a convenience sample of youth aged 13-18 who presented to one of the 28 practices during an 18-month period from January 2020 to July 2021. Clinicians completed surveys evaluating satisfaction with screening in both 2020 and 2021. Response options included a four-point Likert scale ranging from “very dissatisfied” to “very satisfied.”

Results: 5500 charts were audited across 28 settings. 76% (4183/5500) of youth were screened for suicide risk. Training increased screening compliance from 61% at baseline to 87% at the end of the QIP period. Of those screened, 3.1% (132/4183) screened positive and only 0.3% (14/4183) required emergency care. 89% (118/132) of patients at risk for suicide received management in the primary care office and 87% (115/132) were referred to other services. 93% (26/28) of the practices responded to the annual survey addressing satisfaction in screening. At baseline, 26.9% (7/26) of providers reported they were “very satisfied” or “satisfied” with their role in managing suicide risk, compared to 84.6% (22/26) after the 18-month training period.

Conclusion(s):

Suicide risk screening and management in pediatric primary care settings is feasible and did not overburden the system. Implementation through quality improvement methods can significantly improve suicide risk screening compliance and provider satisfaction in managing suicide risk.