Implementation of an evidence-based protocol to improve early suicide risk identification in psychiatric practice

Abstract

Among the top nine leading causes of death for individuals aged 10-64 is suicide, and it's the primary cause of preventable death. Currently, only one-third of healthcare providers routinely screen for suicide risk, even though this screening is recommended by entities such as The Joint Commission. The objectives of this project were to identify ways to increase suicide risk identification in the prevention of suicide through the utilization of a standardized suicide screening using the Ask suicide-screening Questions (ASQ) reflexing to the Brief Suicide Safety Assessment (BSSA), and to mitigate barriers to the implementation of suicide screening protocols in a rural Montana psychiatric practice. This project was accomplished using pre- and post-education surveys and three 2-week PDSA cycles, which evaluated selected aggregate data evaluated against SMART goals. During this project, the facility screened 93% of 86 patients that presented to the practice; 15 patients refused to screen and six were not provided the screening tool. Of the patients screened, 41.3% were positive using the ASQ, with one patient scoring at the threshold for further evaluation with the BSSA. In this sample, none needed further intervention beyond this setting. The project successfully identified the evidence-based tools and processes fitting this practice, provided efficient and convenient implementation steps, gained stakeholder buy-in and support, and facilitated rapid PDSA cycling to identify and mitigate barriers to screening. Per the providers report, additional secondary assessments improved patient care through standardization and consistency, and provided a conversation structure regarding suicide risk. Limitations, including practice size, rurality, and practice specialty, did not indicate a correlation between suicide screening and early risk identification.