Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.

294 Background: From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population. Methods: From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening < 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching. Results: As a new process, the overall screening rate started at 0% and increased to 48% over FY24*. Conclusions: Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community. Data time range: 7/31/23-5/21/24.* FY24 + Quarter Metric Goal Screening Rate Q1 40% 35.7% Q2 50% 34.5% Q3 60% 41.2% Q4 70% 47.8%