The Cost of Universal Suicide Risk Screening for Adolescents in Emergency Departments

Abstract

Suicide is the second leading cause of death among adolescents. As nearly 20% of adolescents visit emergency departments (EDs) each year, EDs have an opportunity to identify previously unrecognized suicide risk. A novel Computerized Adaptive Screen for Suicidal Youth (CASSY) was shown in a multisite study to be predictive for suicide attempts within 3 months. This study uses site-specific data to estimate the cost of CASSY implementation with adolescents in general EDs. When used universally with all adolescents who are present and able to participate in the screening, the average cost was USD 5.77 per adolescent. For adolescents presenting with non-behavioral complaints, the average cost was USD 2.60 per adolescent. Costs were driven primarily by time and personnel required for the further evaluation of suicide risk for those screening positive. Thus, universal screening using the CASSY, at very low costs relative to the cost of an ED visit, can facilitate services needed for at-risk adolescents.

Keywords: adolescent; cost analysis; emergency department; screening; suicide; universal screening.

Figure 1

Flowchart of calculation of personnel time cost per CASSY per site. Note: tablet-based screen; office support staff administer screen; staff reports screen results to RN. Definitions: ED: emergency department. BH: behavioral health. LPN: licensed practical nurse. RN: registered nurse. CBSA: core-based statistical area, a Bureau of Labor Statistics unit of population.