Utilization of a suicide screening tool to increase suicide screening in adults in the emergency department
Creators: name: Torpey, Robin
name: Torpey, Lauren
Publisher: name: No Publisher Supplied
Year: 2020

description: Purpose of Project: Depression is a common and treatable illness characterized by cognitive and physical dysfunction (Centers for Disease Control and Prevention [CDC], 2018). It is a leading cause of disability and may potentially lead to suicide (Friedrich, 2017). Unfortunately, depression seems to remain a stigma, which can possibly lead to poor prognosis. Thus, according to the U.S. Preventative Services Task Force (USPSF), it is strongly recommended that screening for depression and suicide be enabled, especially in those facilities who possess the appropriate resources (2016). Facilities available may include physician offices, clinics, urgent care centers, and emergency departments (EDs). Unfortunately, not all facilities routinely screen for depression. Several EDs lack the proper tools necessary to promptly identify those at risk for depression and suicide (The Joint Commission [TJC], 2016). This may be due to a variety of issues including inadequate regulations, outdated policies, insufficient staff training, and poor integration with other health settings in the community (Agency for Healthcare Research and Quality [AHRQ], 2016). To address this issue, it is vital to ensure health care providers in the emergency room are actively screening all individuals for mental health illness, specifically depression and suicide. The purpose of this study is to foster increased awareness and early detection of depression and suicide risk.Methodology: This project was a quality improvement study that used a quasi-experimental approach, involving prospective and retrospective chart-review data. Data was collected and analyzed to determine the effectiveness of the implemented suicide screening tool in association with prompt detection, diagnosis, treatment, and appropriate referrals. Behavioral health stigma was also evaluated among ED nurses using pre and post surveys to determine the relationship between nursing perception of suicide and effective screening.Results: Nurse Survey Findings - After implementation of the suicide screening tool in the Monmouth county ED, SOSS survey scores remained the same. Both the pre- and post- survey scores illustrated a neutral level of stigma against suicide. Thus, nurses’ views of those who commit suicide may not have been influenced despite education and practice change. In comparison, the Middlesex county ED had a statistically significant difference in results between the pre- and post- survey. This may indicate that stigma levels decreased among nurses after education and reinforcement of the importance of effectively utilizing the suicide screening tool. Patient Findings - At the Monmouth county ED, before the implementation of the PSS-3 tool, only 10% of patients were screened for suicide. Of the 191 patients, five who had a chief complaint other than a psychiatric problem received a consultation. With the newly implemented screening tool, there was a 40% increase in psychiatric consults and a 58% increase in admission for further evaluation and treatment. At the Middlesex county ED, 93% of patients were screened retrospectively. However, only two patients received a psychiatric consult, and both had a chief complaint of “suicide”. After education, screening increased by 3%. Not only were more patients screened, psychiatric referrals and admissions doubled. Implications for Practice: Clinical Practice - The emergency room proves to be an ideal setting for diagnosing and treating mental health disorders as well as suicide. Screening should be done no matter the chief complaint.Healthcare Policy - This study follows the suggestions published by The Joint Commission (Sentinel Alert Event 56) that steps be put in place to detect suicide ideation.Quality and Safety - Prevention and screening have the potential to greatly reduce suicide rates, promoting quality care.Education - One of the most successful prevention strategies involves programs that educate health care professionals. This study displayed that with education nurses were more aware and motivated to effectively screen for suicide.Economic Implications - This project is an economically low-cost intervention in the ED.