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Introduction: Standardized suicide risk assessment improves the detection of individuals at risk of suicide. We conducted a quality improvement initiative in a system of outpatient behavioral health practices affiliated with a free-standing children's hospital to implement standardized suicide risk assessment for new patients. Methods: Clinicians received education in suicide risk assessment and were trained to use an evidence-based suicide risk assessment tool, the Columbia Suicide Severity Rating Scale (C-SSRS). We standardized workflow processes and integrated the C-SSRS in the electronic health record with a feature to communicate instances of elevated risk across care teams through a problem list. We analyzed C-SSRS responses and adherence to standardized processes and compared the percentage of patients with a suicide-related item on the problem list before and after implementation. We assessed clinician knowledge through a survey. All patients with identified suicide risk received treatment to reduce their risk of suicide in the context of usual care. Results: For 3,972 new patient visits occurring postimplementation (November 2016-December 2018), the average monthly adherence to the standardized process was 97.7%. The mean monthly incidence of nonspecific active suicidal thoughts was 16%, aborted suicide attempts were 2%, and actual suicide attempts were 3%. The mean monthly incidence of a suicide-related item documented on the problem list was 5.66% in the postimplementation period compared with 1.47% in the 1-year preimplementation. Clinicians demonstrated statistically significant increases in knowledge about suicide risk factors and assessment. Conclusions: Standardization of suicide risk assessment processes improved detection and documentation of suicide risk in a pediatric outpatient behavioral health setting.
RESUMO
BACKGROUND: Posttraumatic stress (PTS) disorder after injury is a significant yet underaddressed issue in the trauma care setting. Parental anxiety may impact a child's risk of future, persistent PTS symptoms after injury. This study aimed to: (1) identify injury incident and demographic variables related to a positive screen for future, persistent PTS symptoms in children; and (2) examine the relationship between parental anxiety and a positive screen for future, persistent PTS symptoms in children. METHODS: From November 2009 to August 2010, 124 patients were enrolled at a pediatric trauma center. Inclusion criteria were as follows: (1) age 7 years to 17 years; (2) hospitalized for at least 24 hours after physical trauma; and (3) English or Spanish speaking. State and trait anxiety were measured for both pediatric patients and their parents/guardians via the state trait anxiety inventory for children and state trait anxiety inventory, respectively. Risk for future, persistent PTS, among pediatric patients was assessed via the screening tool for early predictor of posttraumatic stress disorder (STEPP). RESULTS: Of 116 participants assessed via the STEPP, 32 (28%) screened positive for risk of future, persistent PTS symptoms. Motor vehicle collision and parental presence at injury were associated with a positive STEPP screen. The effect of parental presence on positive STEPP screen was modified by parental trait anxiety. Children of anxious parents present at injury were over 14 times as likely to screen positive for risk of future, persistent PTS, as those without a parent present. CONCLUSION: The risk of future, persistent PTS, after injury among the pediatric population is substantial. Parents with existing trait anxiety are shown to influence their child's risk for future, persistent PTS, particularly if present at the injury event. Further study of PTS prevention and control strategies are needed among this population within the trauma care setting. LEVEL OF EVIDENCE: Epidemiological study, level II.
