(171) Screening for and Assessment of Suicide Risk in Patients with Medical Illness: A Quality Improvement Initiative

Abstract: Significance: Suicide is a major public health problem in the United States and is currently the 10^th leading cause of death in the general population. Medical illness itself is a risk factor for suicide, and the assessment and management of suicide is a core competency for CL psychiatrists. For example, the risk of death by suicide among oncology patients is about twice as high as the general population (McFarland, 2019), and varies by both cancer site and time since diagnosis. Consequently, there is compelling justification for suicide risk screening of medically ill patients in a compassionate and non-stigmatizing way.



Background: UNC Health, an 18-hospital system, is currently modifying its suicide risk screening process to be more patient-centric, acceptable to clinicians, and efficient regarding resource utilization (Horowitz, 2020). This modification involves implementation of new screening and assessment instruments, changes to the electronic medical record, policy revision, and workforce education. This project focuses on the implementation of this process among medical and surgical patients admitted to a large academic hospital.



Methods: A systematic quality improvement (QI) project was conducted at the UNC Medical Center. Components of the project included: identification of key stakeholders, process mapping, a change driver diagram for the Ask Suicide Questions (ASQ) and Brief Suicide Safety Assessment (BSSA) tools, a staff education campaign, and data collection from ongoing plan-do-study-act (PDSA) cycles.



Results: Outcome measures include the frequency of missed and repeated screens, and pilot data regarding outcomes of the ASQ/BSSA. Ongoing process measures include how often the correct workflow occurs following screening, educational targets such as percent of staff trained, and surveys of workforce attitudes pertaining to the new workflow and its implementation. An important balancing measure is the number of 1:1 observers employed due to suicide risk.



Discussion: An analysis of data trends for both the screening and assessment outcomes, as well as workforce attitudes towards the new process will be presented. Potential implementation barriers and unintended consequences will also be reported.



Conclusion: This project of implementing a validated suicide screening and assessment project in a medically ill inpatient population has identified several opportunities for improved care of patients at risk for suicide, and for the improved training of healthcare workers regarding suicide risk assessment.



References:

1. CDC, National Center for Health Statistics. Underlying Cause of Death 1999-2019 on CDC WONDER Online Database, released in 2020. Accessed at https://wonder.cdc.gov/ucd-icd10.html on Feb 3, 2021.

2. Horowitz, LM, Snyder DJ, Boudreaux ED, et. al. Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages. Psychosomatics. 2020; 61(6):713-722.

3. McFarland D, Walsh L, Napolitano S, et al. “Suicide in Patients with Cancer: Identifying Risk Factors”. Oncology Vol 33, No 6. 19 June, 2019.