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Citation
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Coleman KJ, Stewart CC, Bruschke C, Flores JP, Altschuler A, Beck A, Lynch FL, Owen-Smith AA, Richards JE, Rossom R, Simon GE, Sterling S, Ahmedani BK. Adv. Psychiatry Behav. Health 2021; 1(1): 67-76. |
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Abstract
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The following six actions are recommended to implement wide-scale screening for suicide risk:
• Health System "Buy-In". Align screening for suicide risk with efforts clinical systems have already made in obtaining patient-reported outcomes to assist executive leadership achieve goals in which they are already invested.
• Cross-Disciplinary Collaboration. Assemble key decision-makers in a workgroup that is coordinated by staff dedicated to the initiative.
• Evidence-Based Screening Tools. Use validated instruments recommended by the Joint Commission.
• Electronic Health Record-Embedded Clinical Tools. Automate any screening algorithm and collection of patient-reported outcomes using discrete, abstractable structured formats (eg, questionnaires, flowsheets, and so forth) that can be easily assembled for reporting and quality improvement.
• Well-Defined Clinical Workflows. Define clear workflows that outline who is responsible for what aspects of the screening, depending on the algorithms developed and data obtained from the electronic health record-embedded clinical tools.
• Performance Feedback. Create and maintain a regular set of metrics with benchmarks for screening from the electronic health record-embedded clinical tools that can be distributed to all clinical partners involved in the work.
A recent report from the National Center for Health Statistics at the Centers for Disease Control and Prevention found that death from suicide increased by 35% across U.S. populations from 1999 to 2018 [1]. It is estimated that for every suicide death, there are 25 attempts [2], suggesting multiple opportunities for prevention. Increasing suicide rates have prompted many national organizations to improve identification and intervention strategies for those at highest risk. For example, the Joint Commission released an official National Patient Safety Goal on suicide prevention to be implemented in all hospital settings by July 2020 [3]. In response to multiple agency recommendations regarding suicide prevention, the Suicide Prevention Resource Center was created to address suicide prevention throughout the U.S. [4]. As part of their efforts, in partnership with other collaborating national advocacy groups, they created the Zero Suicide Framework specific to health care settings [5].
The Zero Suicide Framework is a flexible set of evidence-based clinical practices and implementation strategies encompassing seven domains (lead, train, identify, engage, treat, transition, and improve) that are designed to mitigate suicide risk, enhance protective factors, and close gaps in health care that leave at-risk patients vulnerable [5]. The domains are meant to be used as needed, depending on the resources of any one health care system, and are designed as a set of recommendations to improve the quality of suicide-prevention efforts. One of the key clinical practices of this framework is "identify" which includes two components: screening for suicidal ideation and assessment of suicide risk including intent and plans. Without identifying those at risk for suicide, there is no opportunity to enact the clinical practices of the framework: engage, treat, and transition.
Language: en |