Soffer Stephen L, Lewis Jason, Lawrence O'Nisha S, Marroquin Yesenia A, Doupnik Stephanie K, Benton Tami D
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania.
Pediatr Qual Saf. 2022 Jun 14;7(3):e571. doi: 10.1097/pq9.0000000000000571. eCollection 2022 May-Jun.
Standardized suicide risk assessment improves the detection of individuals at risk of suicide. We conducted a quality improvement initiative in a system of outpatient behavioral health practices affiliated with a free-standing children's hospital to implement standardized suicide risk assessment for new patients.
Clinicians received education in suicide risk assessment and were trained to use an evidence-based suicide risk assessment tool, the Columbia Suicide Severity Rating Scale (C-SSRS). We standardized workflow processes and integrated the C-SSRS in the electronic health record with a feature to communicate instances of elevated risk across care teams through a problem list. We analyzed C-SSRS responses and adherence to standardized processes and compared the percentage of patients with a suicide-related item on the problem list before and after implementation. We assessed clinician knowledge through a survey. All patients with identified suicide risk received treatment to reduce their risk of suicide in the context of usual care.
For 3,972 new patient visits occurring postimplementation (November 2016-December 2018), the average monthly adherence to the standardized process was 97.7%. The mean monthly incidence of nonspecific active suicidal thoughts was 16%, aborted suicide attempts were 2%, and actual suicide attempts were 3%. The mean monthly incidence of a suicide-related item documented on the problem list was 5.66% in the postimplementation period compared with 1.47% in the 1-year preimplementation. Clinicians demonstrated statistically significant increases in knowledge about suicide risk factors and assessment.
Standardization of suicide risk assessment processes improved detection and documentation of suicide risk in a pediatric outpatient behavioral health setting.
标准化自杀风险评估可提高对有自杀风险个体的检测。我们在一家独立儿童医院附属的门诊行为健康实践系统中开展了一项质量改进计划，对新患者实施标准化自杀风险评估。
临床医生接受了自杀风险评估方面的教育，并接受培训以使用基于证据的自杀风险评估工具——哥伦比亚自杀严重程度评定量表（C-SSRS）。我们规范了工作流程，并将C-SSRS整合到电子健康记录中，通过问题列表实现跨护理团队沟通风险升高情况的功能。我们分析了C-SSRS的回答和对标准化流程的依从性，并比较了实施前后问题列表上有自杀相关项目的患者百分比。我们通过一项调查评估临床医生的知识水平。所有确定有自杀风险的患者在常规护理背景下接受降低自杀风险的治疗。
在实施后（2016年11月至2018年12月）发生的3972次新患者就诊中，每月对标准化流程的平均依从率为97.7%。非特异性主动自杀念头的平均月发生率为16%，自杀未遂为2%，实际自杀未遂为3%。在实施后期间，问题列表上记录的与自杀相关项目的平均月发生率为5.66%，而在实施前1年为1.47%。临床医生在自杀风险因素和评估知识方面有统计学上的显著提高。
自杀风险评估流程的标准化改善了儿科门诊行为健康环境中自杀风险的检测和记录。
