A quality improvement program developed by the Parkland Health & Hospital System could lead to the creation of a national model to help identify patients who may be at risk for suicide but often go undetected.
A case study, published in the January issue of The Joint Commission Journal on Quality and Patient Safety, looks at the success of the Dallas safety-net healthcare system’s universal suicide screening in the inpatient, outpatient and emergency care settings.
Suicide is the 10th leading cause of death in the United States. And many adults who commit suicide often seek nonbehavioral healthcare prior to their death but clinicians didn’t detect the risk, according to the Joint Commission.
The study, led by Kimberly Roaten, Ph.D., associate professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, looks at how the Parkland system developed and implemented the program, including the screening process, the clinical response, an electronic health record screening protocol and education of the clinical workforce.
To determine the success of the program, researchers reviewed data for more than 328,000 adult encounters from the first six months of the screening program. Of patients who screened positive for suicide risk, 6.3% were in the emergency department, 2.1% were in the outpatient clinics and 1.6% were in the inpatient units. The odds of a positive suicide screening in the ED were 4.29 times higher than in the inpatient units and 3.13 times higher than in the outpatient clinics.
The screening program calls for nurses, physicians or administrative personnel to conduct a suicide risk screening by asking a simple series of questions after the patient is checked in and evaluated by nursing staff triage. If the screening suggests the patient is a suicide risk, he or she receives a mental health screening along with appropriate medical care.
As of September 2017, staff members have completed more than 1.6 million suicide screenings. Researchers note the hospital is now reinforcing education and providing feedback to frontline staff about culture change and patient safety improvements. The system is also in the process of expanding its telehealth capabilities to speed up clinical responses for at-risk patients and will expand the program to on-campus outpatient specialty clinics once funding is available.
In an accompanying opinion piece, healthcare experts led by author Lisa M. Horowitz, Ph.D., a staff scientist at the Patient Safety & Quality Intramural Research Program, National Institute of Mental Health, write that Parkland has taken an important step in documenting the feasibility and value of adding universal risk screening to identify patients who may only disclose suicidal thoughts and behaviors if they are asked directly.
“In doing so, Parkland provides an exemplary model that other health systems could follow to increase the chance that individuals who are struggling in silence may be recognized and treated,” they wrote.