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. 2021 Sep-Oct;21(7):1179-1186.
doi: 10.1016/j.acap.2021.05.019. Epub 2021 May 28.

Quality of Care for Youth Hospitalized for Suicidal Ideation and Self-Harm

Sarah K Connell  1 , Q Burkhart  2 , Anagha Tolpadi  2 , Layla Parast  2 , Courtney A Gidengil  3 , Steven Yung  4 , William T Basco  5 , Derek Williams  6 , Maria T Britto  7 , Mark Brittan  8 , Kelly E Wood  9 , Naomi Bardach  10 , Julie McGalliard  11 , Rita Mangione-Smith  12 ; Pediatric Research in Inpatient Settings (PRIS) Network
Affiliations

Quality of Care for Youth Hospitalized for Suicidal Ideation and Self-Harm

Sarah K Connell et al. Acad Pediatr. 2021 Sep-Oct.

Abstract

Objective: To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization.

Methods: Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions.

Results: Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07-2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24-0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28-0.83).

Conclusions: This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.

Keywords: inpatient; mental health; quality of care; readmission; youth.

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Conflict of interest statement

Conflict of interest: All authors declare no conflict of interest.

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