Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America.
J Affect Disord. 2024 Oct 1;362:536-542. doi: 10.1016/j.jad.2024.07.079. Epub 2024 Jul 15.
Suicide is a leading cause of death among youth in the United States. Pediatric emergency department visits for non-psychiatric concerns present an opportunity to identify youth at risk for suicidality. This quality improvement initiative was undertaken to ensure that those patients identified as low risk for suicide receive resources, bridging the gap between identifying at-risk youth and providing them with appropriate follow up mental health resources. The aim of this project was to increase the proportion of after visit summaries containing mental health resources by 25 % within 6 months for medical patients who are found to have non-acute low suicide risk and are discharged from the emergency department.
The primary outcome measure was the proportion of discharged medical patients who screened positive for suicidal ideation and were determined to be at low risk for suicide who received mental health resources on discharge before and after intervention. A multidisciplinary team targeted the following 3 key drivers: 1) multidisciplinary engagement 2) training and education of providers and 3) health information technology. Plan, Do, Study and Act cycles included the following: 1) an educational campaign with regular multidisciplinary meetings, educational updates, and email reminders; 2). an electronic health record change; and 3) An individual report to providers.
After the intervention, the percentage of medical patients with low-risk suicidality being discharged with mental health resources increased by more than 70 %.
A champion led multidisciplinary team, using PDSA methodology, can implement sustained improvements in mental health resource distribution.
自杀是美国青少年死亡的主要原因之一。儿科急诊就诊非精神科就诊为识别有自杀风险的青少年提供了机会。这项质量改进计划的目的是确保那些被认为自杀风险低的患者获得资源，从而弥合识别高危青少年和为他们提供适当后续心理健康资源之间的差距。该项目的目的是在 6 个月内将有非急性低自杀风险且从急诊室出院的医疗患者的就诊后总结中包含心理健康资源的比例提高 25%，这些患者经筛查后有自杀意念且被确定为自杀风险低。
主要结果衡量标准是接受筛查后有自杀意念且被确定为自杀风险低的出院医疗患者在干预前后接受心理健康资源的比例。一个多学科团队针对以下 3 个关键驱动因素：1）多学科参与；2）提供者的培训和教育；3）医疗信息技术。计划、执行、研究和行动循环包括以下内容：1）一项教育运动，包括定期的多学科会议、教育更新和电子邮件提醒；2）电子病历变更；3）向提供者提供个人报告。
干预后，有低自杀风险的医疗患者出院时获得心理健康资源的比例增加了 70%以上。
一个由冠军领导的多学科团队，使用 PDSA 方法，可以持续改进心理健康资源的分配。
