Journal
PSYCHOSOMATICS
Volume 60, Issue 1, Pages 1-9Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.psym.2018.09.003
Keywords
suicide risk; screening; clinical pathway; consultation-liaison psychiatry; pediatrics
Categories
Funding
- American Academy of Child and Adolescent Psychiatry's 2017 Abramson Fund Grant
- Intramural Research Program of the National Institute of Mental Health of the National Institutes of Health [ZIA MH002922-10]
- NATIONAL INSTITUTE OF MENTAL HEALTH [ZIAMH002922] Funding Source: NIH RePORTER
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Background: Youth suicide is on the rise worldwide. Most suicide decedents received healthcare services in the year before killing themselves. Standardized workflows for suicide risk screening in pediatric hospitals using validated tools can help with timely and appropriate intervention, while attending to The Joint Commission Sentinel Event Alert 56. Objective: Here we describe the first attempt to generate clinical pathways for patients presenting to pediatric emergency departments (EDs) and inpatient medical settings. Methods: The workgroup reviewed available evidence and generated a series of steps to be taken to feasibly screen-medical patients presenting to hospitals. When evidence was limited, expert consensus was used. A standardized, iterative approach was utilized to create clinical pathways. Stakeholders reviewed initial drafts. Feedback was incorporated into the final pathway. Results: Clinical pathways were created for suicide risk screening in pediatric EDs and inpatient medical/surgical units. The pathway outlines a 3-tiered screening process utilizing the Ask Suicide-Screening Questions for initial screening, followed by a brief suicide safety assessment to determine if a full suicide risk assessment is warranted. This essential step helps conserve resources and decide upon appropriate interventions for each patient who screens positive. Detailed implementation guidelines along with scripts for provider training are included. Conclusion: Youth suicide is a significant public health problem. Clinical pathways can empower hospital systems by providing a guide for feasible and effective suicide risk-screening implementation by using validated tools to identify patients at risk and apply appropriate interventions for those who screen positive. Outcomes assessment is essential to inform future iterations.
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