Spreading a strategy to prevent suicide after psychiatric hospitalization: Results of a quality improvement spread initiative

Background
Suicide after psychiatric hospitalization is a major concern. Poor treatment engagement may contribute to risk. The World Health Organization Brief Intervention and Contact (BIC) Program is an evidence-based practice shown to prevent suicide after psychiatric discharge in international trials. There have been no efforts to implement BIC into routine practice in US populations.
Methods
We conducted a 12-month Quality Improvement (QI) collaborative at six, Department of Veterans Affairs (VA) Medical Centers serving a large rural population. Sites had low to moderate performance on a VA quality measure of mental health post-discharge care; a measure assessing the proportion of discharged patients who achieve the required number of visits ≤ 30-days. Sites received programmatic support to implement BIC locally. We assessed implementation using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Results
Overall teams had high participation in programmatic activities and enrolled 85% of eligible patients that they approached. Among 70 enrolled patients, 81.4% achieved the VA quality measure of mental health post-discharge care, suggesting good treatment engagement. On average, patients rated BIC as excellent. Team members agreed that BIC was easy to use, implementable, possible and doable. Factors facilitating implementation included standardized operating procedures to standardize processes. Barriers included insufficient staffing and loss to follow-up. Most sites plan to continue to enroll patients and to expand BIC to other areas.
Conclusions
A QI Collaborative can facilitate implementation of BIC in six VA facilities that provide inpatient psychiatric treatment. BIC may appeal to patients and providers and may improve treatment engagement.