Impact of a standardized suicide screening tool for veterans in a primary care setting

Veteran suicide remains a critical public health concern, with many veterans receiving the majority of their care in civilian primary care settings. This Doctor of Nursing Practice (DNP) quality-improvement (QI) project evaluated the impact of implementing the Veterans Affairs (VA) S.A.V.E. Gatekeeper Training—an evidence-based suicide-prevention curriculum—combined with workflow changes in a suburban ambulatory clinic serving a large veteran population. The project aimed to strengthen clinical staff knowledge, confidence, and suicide-prevention practices, ultimately improving the identification and referral of veterans at risk for suicide.Ten (n=10) clinical staff members participated in the project and completed pre- and post-intervention assessments measuring their knowledge and confidence in using the Suicide Assessment Scale (SAS). The intervention consisted of evidence-based VA and PsychArmor S.A.V.E. training, facilitated discussion, simulation activities, and incorporation of universal military-service screening and visible veteran resource materials across exam rooms. Staff began routinely asking adult patients about military service and completing a veteran suicide-risk questionnaire to inform provider assessment and referral.Findings demonstrated significant improvements in staff capability. Knowledge scores increased from 17.38 to 21.63 (p = .000), and confidence scores rose from 17.25 to 21.88 (p = .000). Process outcomes showed substantial clinic-level changes over six months: suicide-risk screening increased from 16% to 100%, identification of at-risk veterans rose from 16% to 60%, and referrals to mental health services increased from 4% to 50%. A small percentage of veterans (2%) required higher-level care post-implementation. These results indicate that pairing concise gatekeeper training with simple workflow redesign can rapidly enhance suicide-prevention practices in civilian primary care.This QI pilot suggests a scalable, low-burden approach to improving early identification and referral of at-risk veterans. Sustaining gains will require continued workflow integration, standardized screening prompts, and periodic refresher education.