P0131 - Improving detection of children at risk for suicide through universal screening in the emergency department

Background: Suicide is the second leading cause of death in older children. Suicide has tripled in children 10-14 years and increased by 75% in adolescents 15-19 years from 2007-2017. Because children at risk for suicide may be difficult to detect, routine screening is necessary. The emergency department (ED) is an ideal location to perform screening because adolescents who use the ED engage in risky behaviors. However, during the pre-implementation period of this study only 1% of children >11 presenting to this ED were screened for suicidality.

Objective: We aimed to identify children at risk of suicide by implementing universal screening to increase the rate of suicide screening from 1% to 90% in children ≥11 years old who presented to the ED between Oct 2018-Dec 2019.

Methods: As the primary intervention, a multidisciplinary team developed a tablet-based application of the Ask-Suicide Screening Questions, a 5-question validated tool that identifies youth at-risk for suicide. Stakeholder feedback was used to identify the best method for implementation. Key interventions included nursing education, project promotion in the monthly newsletter, and individual recognition and feedback. All children ≥11 years old, unless medically unstable or developmentally delayed, were eligible. Providers were alerted of positive screens through the electronic health record and ordered a social work consult if additional resources were needed. The process measure was percent of patients screened. Outcome measures were the percent of positive suicide screens and social work consults. The balancing measure was ED length of stay (LOS). Measures were analyzed with statistical control charts and descriptive statistics.

Results: From Oct 2018-Dec 2019, 17,253 patients ≥11 years old presented to the ED. Screening improved from 1% to 84% (n=13,523) (Figure 1). Of those screened, 14% (n=1,950) had a positive screen and 3% (n=420) needed a social work consult (Figure 2). 1% (n=146) required immediate transfer to an inpatient psychiatric facility, most (n=143) of whom presented for suicidal ideation/attempt. Of patients who had a positive screen, 88% (n=1,720) presented to the ED for a non-behavioral issue and 3 of them required immediate inpatient psychiatric transfer. LOS remained unchanged (192 min).

Conclusion: Universal screening increased suicide screening to 84%, without extending the LOS. Screening identified 3 patients requiring immediate inpatient psychiatric hospitalization who may not have been identified otherwise.