Children's National Hospital, Washington, District of Columbia; and.
Sidra Medicine and Research Center, Doha, Qatar.
Hosp Pediatr. 2020 Oct;10(10):884-892. doi: 10.1542/hpeds.2020-0039. Epub 2020 Sep 14.
Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children's hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS).
A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation.
Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment.
A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.
现在，获得联合委员会（TJC）认证的医院被要求在所有行为健康患者中使用经过验证的筛查工具和标准化方法来评估自杀风险。我们这项研究的目的是：（1）在一家大型三级儿童医院的儿科急诊室（ED）和门诊行为健康诊所实施符合 TJC 标准的自杀风险筛查和评估流程；（2）描述与自杀风险相关的人群特征；（3）报告该新流程对 ED 住院时间（LOS）的影响。
制定并实施了使用哥伦比亚自杀严重程度评定量表的工作流程。每月对筛查和评估的依从性进行审查。采用描述性统计方法定义研究人群，并采用多变量回归模型分析与高自杀风险和从 ED 出院相关的因素。比较实施前后 ED 行为健康患者的 LOS。
ED 的筛查平均符合率为 83%，门诊诊所为 65%。ED 标准化评估的依从率从实施前的 0%提高到 88%。分析显示，ED 行为健康患者中有 72%存在自杀风险，门诊行为健康患者中有 18%存在自杀风险。ED LOS 没有增加。经过评估，大多数筛查风险患者从医院出院。
在 ED 和门诊行为健康诊所为行为健康患者实施了符合 TJC 标准的自杀风险筛查和评估流程，而 ED LOS 没有增加。
