Quality initiative: Screening suicide risk in the primary care setting in order to promote early detection of suicide ideation

Purpose of Project: The purpose of the QI project was to implement a standardized screening tool in the primary care setting to measure suicide risk in adult patients. The project sought to enhance the detection of suicidal ideation, provide support to at-risk patients, and bridge the gap between primary care and mental health services. Methods: This quality improvement project was conducted at a rural primary care office in Johnston County, North Carolina. The project spanned over 12 weeks and consisted of two weeks of educational sessions with staff, eight weeks of screening implementation, and two weeks of data collection. The PI collected paper-based C-SSRS screenings and conducted a chart review of positive screenings to monitor behavioral health referrals and clinical outcomes. Over the 8 weeks, a total of 74 patients had completed the suicide risk screenings (n = 74) out of the 98 patients who met the inclusion criteria. Results: The results showed that patients were screened and assessed as follows: low-risk, n = 68 (91.89%); moderate risk, n = 6 (8.1%); and high-risk, n = 0 (0%). All patients who screened as moderate risk for suicide were referred to behavioral health, n = 6 (100%). Implications for Practice: The U.S. Preventive Services Task Force (USPSTF) (2023) concluded there is insufficient evidence to support universal screening of suicide risk in adult primary care patients. However, the recommendation highlights a research need to determine how suicide risk screening should be implemented, and which screening instrument should be utilized (USPSTF, 2023). Although this QI project had a small sample size and was conducted over a short time, its findings may inform further research on healthcare policy and universal screening recommendations. Providers should utilize evidence-based screening tools, such as the C-SSRS, to accurately identify patients at risk and follow up with a provider assessment to stratify the risk level and provide the appropriate intervention, including early referral to behavioral health.