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Review
. 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

Khyati Brahmbhatt  1 , Brian P Kurtz  2 , Khalid I Afzal  3 , Lisa L Giles  4 , Elizabeth D Kowal  5 , Kyle P Johnson  6 , Elizabeth Lanzillo  7 , Maryland Pao  8 , Sigita Plioplys  9 , Lisa M Horowitz  10 ; PaCC Workgroup
Affiliations
Review

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

Khyati Brahmbhatt et al. Psychosomatics. 2019 Jan-Feb.

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.

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Conflict of interest statement

Declarations of Interest:

Khyati Brahmbhatt MD: None

Brian Kurtz MD: Grant support -PCORI and CF Foundation

Khalid Afzal MD: None

Lisa Giles MD: None

Elizabeth Kowal MD: None

Kyle Johnson MD: None

Elizabeth Lanzillo: None

Maryland Pao MD: Co-Author of ASQ and Council Member of the Academy of Consultation-Liaison Psychiatry

Sigita Plioplys MD: None

Lisa Horowitz PhD, MPH: Author of ASQ

References

    1. Suicide Data. Mental Health: World Health Organization; 2016. [cited 2018 July 31]. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.
    1. Leading Causes of Death Reports, 1981 – 2016. National Center for Injury Prevention and Control: Centers for Disease Control and Prevention 2016. [cited 2018 July 31]. Available from: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html.
    1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System. National Center for Injury Prevention and Control, CDC 2016. National Center for Injury Prevention and Control: Centers for Disease Control and Prevention 2016. [cited 2018 July 31]. Available from: https://www.cdc.gov/injury/wisqars/fatal.html.
    1. Stone DMSTR, Fowler KA, Kegler SR, Yuan K, Holland KM,Ivey-Stephenson AZ, Crosby AE. Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015. 2018;67:617–24. - PMC - PubMed
    1. QuickStats: Death Rates for Motor Vehicle Traffic Injury, Suicide, and Homicide Among Children and Adolescents aged 10–14 Years — United States, 1999–2014. Centers for Disease Control and Prevention 2016. [cited 2018 July 31]. Available from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6543a8.htm?s_cid=mm6543a8_w.

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