Universal suicide screening in a pediatric gastroenterology outpatient clinic
Problem and Purpose
Suicide is the second leading cause of death in young people ages 10-24 in the United States. The Joint Commission issued a sentinel event recommending healthcare providers screen all patients for suicide. Universal screening is a key strategy to prevent suicide in the pediatric population. This quality improvement (QI) project implemented an evidence-based suicide screening tool for patients ages 10-21 who presented to a multidisciplinary pediatric gastroenterology (GI) outpatient clinic affiliated with a large urban academic medical center and referred at risk patients for further evaluation and treatment.
The Ask Suicide-Screening Questions (ASQ) screening tool was chosen for its robust reliability and validity among pediatric medical patients. The GI clinicians were trained to use the ASQ tool and to further assess at risk patients with a brief suicide safety assessment (BSSA). The clinic social worker screened all patients meeting inclusion criteria, and results were entered into the electronic health record (EHR). Patients were excluded from screening if they were less than age 10, the guardian refused, or the patient could not answer the questions due to a developmental delay. Patients at risk for suicide received a safety plan and follow up resources.
The clinicians self-reported 100% competency prior to implementation. During the implementation phase, sixteen patients met inclusion criteria, and one guardian refused screening. Ten patients had screening results recorded in the EHR (66%), and two patients (20%) were found to be at risk for suicide. Both patients screened positively due to previous suicide attempt(s) which is a strong predictive factor for future suicidal behaviors.
SUICIDE SCREENING IN PEDIATRIC GASTROENTEROLOGY 3
With proper training, the GI clinicians were confident to implement suicide screening using the ASQ tool. Twenty percent of patients screened at risk for suicide and received mental health resources. This QI project validates the feasibility and value of suicide screening in a pediatric subspecialty clinic and suggests screening could be implemented in other subspecialty clinics within the hospital system.