Implementation of a pediatric/adolescent suicide risk screening tool for patients presenting to the Emergency Department with nonbehavioral health complaints

PROBLEM: At a large urban pediatric hospital, from 2015 to 2016, a 44% increase occurred in youth with suicide attempts admitted to medical units. At that time, patients assessed in the Emergency Department (ED) were asked one question to determine suicide risk. METHODS: The Iowa Model served as the framework for the Psychiatry and Emergency Departments to identify an evidence-based suicide screening tool and educate/train all ED nurses on assessing patients for suicide risk. In July 2017, ED nurses began assessing all patients (ages 10 and over) utilizing the Ask Suicide-Screening Questions (ASQ). FINDINGS: In the first 3 months of ASQ implementation, 390 youth were identified in the ED as struggling with sadness/worry or at risk for suicide. Pre-intervention ED nurses' survey results indicated 30% felt inadequately trained in suicide screening; 26% considered the ASQ too time consuming, and 40% agreed there was stigma regarding mental health. Post-education ED nurses' survey results showed improvement in skills (64% felt adequately trained) but there was no significant change in mental health stigma perception. CONCLUSION: Within the first 3 months of assessing all nonbehavioral patients ages 10 and over, there was a 37% increase of ED patients identified as a suicide risk, enabling immediate mental health assessments before suicide attempts.