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Psychosomatics. 2019 Jan - Feb;60(1):1-9. doi: 10.1016/j.psym.2018.09.003. Epub 2018 Sep 22.

Suicide Risk Screening in Pediatric Hospitals: Clinical Pathways to Address a Global Health Crisis.

Author information

1
University of California, San Francisco, Department of Psychiatry and Langley Porter Psychiatric Institute, UCSF Weill Institute for Neurosciences, San Francisco, CA. Electronic address: Khyati.brahmbhatt@ucsf.edu.
2
University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, Cincinnati Children's Hospital Medical Center, Cincinnati OH. Electronic address: Brian.Kurtz@cchmc.org.
3
The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL. Electronic address: Khalid.Afzal@uchospitals.edu.
4
University of Utah School of Medicine, Departments of Pediatrics and Psychiatry, Salt Lake City, UT. Electronic address: lisa.giles@hsc.utah.edu.
5
Michigan State University CHM, Section of Pediatric Behavioral Health, Grand Rapids, MI. Electronic address: Elizabeth.kowal@helendevoschildrens.org.
6
Oregon Health & Science University (OHSU), Department of Psychiatry, Portland, OR. Electronic address: johnsoky@ohsu.edu.
7
National Institute of Mental Health, NIH, Office of the Clinical Director, Bethesda, MD. Electronic address: elizabeth.lanzillo@nih.gov.
8
National Institute of Mental Health, NIH, Office of the Clinical Director, Bethesda, MD. Electronic address: paom@mail.nih.gov.
9
Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: splioply@luriechildrens.org.
10
National Institute of Mental Health, NIH, Office of the Clinical Director, Bethesda, MD. Electronic address: horowitzl@mail.nih.gov.

Abstract

BACKGROUND:

Youth suicide is on the rise worldwide. Most suicide decedents received healthcare services in the year before killing themselves. Standardized workflows for suicide risk screening in pediatric hospitals using validated tools can help with timely and appropriate intervention, while attending to The Joint Commission Sentinel Event Alert 56.

OBJECTIVE:

Here we describe the first attempt to generate clinical pathways for patients presenting to pediatric emergency departments (EDs) and inpatient medical settings.

METHODS:

The workgroup reviewed available evidence and generated a series of steps to be taken to feasibly screen medical patients presenting to hospitals. When evidence was limited, expert consensus was used. A standardized, iterative approach was utilized to create clinical pathways. Stakeholders reviewed initial drafts. Feedback was incorporated into the final pathway.

RESULTS:

Clinical pathways were created for suicide risk screening in pediatric EDs and inpatient medical/surgical units. The pathway outlines a 3-tiered screening process utilizing the Ask Suicide-Screening Questions for initial screening, followed by a brief suicide safety assessment to determine if a full suicide risk assessment is warranted. This essential step helps conserve resources and decide upon appropriate interventions for each patient who screens positive. Detailed implementation guidelines along with scripts for provider training are included.

CONCLUSION:

Youth suicide is a significant public health problem. Clinical pathways can empower hospital systems by providing a guide for feasible and effective suicide risk-screening implementation by using validated tools to identify patients at risk and apply appropriate interventions for those who screen positive. Outcomes assessment is essential to inform future iterations.

KEYWORDS:

clinical pathway; consultation-liaison psychiatry; pediatrics; screening; suicide risk

PMID:
30384966
DOI:
10.1016/j.psym.2018.09.003
[Indexed for MEDLINE]

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