• Implementing Psychiatric Safety Planning in the Adult Emergency Setting to Decrease Re-Presentation

      Butchart, Julie; Satyshur, Rosemarie D. (2020-05)
      Problem & Purpose: In the previous year, of those who complete suicide, 31.1% were seen in the emergency department (Schaffer et al., 2016). This statistic presents an important opportunity for intervention within healthcare. The purpose of this quality improvement project was to improve discharge planning by implementing the Stanley Brown Safety Plan (SBSP) in the Psychiatric Emergency Service (PES) for patients who report suicidality before discharged. Methods: This project implemented the SBSP within the adult PES of a large urban academic hospital. The process change was to measure the number of patients who have documentation related to the SBSP in their chart upon chart audit. The data collection process utilized a “student- developed” chart audit model based on an electronic medical record report that is composed of date, CSN of patient, staff member, and whether the SBSP or refusal of participation was documented. The structure measures were education of the staff and feedback provided to the staff based on weekly audits. Results: Education of staff pre-implementation and individualized feedback provided had 100% compliance throughout the project. Patients who had documentation of SBSP or refusal to participate in their project in their chart was successful; demonstrated by weekly improvement throughout the project and project high of 82% in the last week. The compliance ranged from 29% to 82% with a median of 41.5, a mean of 53.8 and a standard deviation of 15.8. Re-presentation rates increased from 18% in the first month data was recorded to 34% in the last month of recorded data with a median of 29.6, a mean of 28.6 and a standard deviation of 4.7. Conclusion: Clinical staff’s knowledge on safety planning improved after education training. The documentation score suggests that the standardized safety planning protocol was easy to use and implement as the standard of care. Findings highlighted the confounding variables that effected the safety planning protocol’s ability to prevent re-presentation. Standardizing the safety planning protocol and educating the clinical staff on safety planning not only improved the documentation but is essential to improving discharge planning for the suicidal patient.
    • Universal Suicide Screening in a Pediatric Gastroenterology Outpatient Clinic

      Stankiewicz, Morgan H.; Wise, Barbara V. (2020-05)
      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. Methods: 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. Results: 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. Conclusions: 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.