Screening Adult Medical Inpatients for Suicide Risk

Background and Purpose: Suicide recently advanced to the 10^th leading cause of death for adults in the US. Early detection is a critical suicide prevention strategy. Hospitals are uniquely positioned to capture patients at risk for suicide. While the Joint Commission (JC) has recommended screening medical patients for suicide risk, validated screening tools are lacking. As hospitals across the country begin to screen medical patients for suicide risk, challenges arise in how to effectively and efficiently screen and manage medical inpatients once suicide risk is identified. What is the experience of the healthcare team, including social workers, on the use of a suicide screening tool in adults admitted to inpatient units in a hospital setting? This presentation will describe a pilot suicide screening quality improvement project (QIP) and subsequent research study that addressed suicide screening in the medical setting at the National Institutes of Health Clinical Center.

Methods: Conducted a QIP called asQ`em (Ask Suicide Screening Questions to Everyone in Medical Settings) using the plan-do-study-act method at the NIH Clinical Center (NIH CC), approved by the NIH Office of Human Subjects Research. A convenience sample of adult medical / surgical inpatients was screened for suicide risk using a brief, 2-item asQ`em instrument during the initial nursing assessment with subsequent mental health follow-up for positive screens. Feedback surveys were administered to patients, nurses, and social workers to gather data about their experience.  This QIP led to an IRB-approved instrument development suicide screening study which enrolled 140 adult medical inpatients . Participants completed several questionnaires including a gold standard risk of suicide questionnaire, the Adult Suicidal Ideation Questionnaire (ASIQ).  Positive screens were managed by Social Work and Psychiatry departments.

Results: QIP results: A total of 331 patients were screened; 13 (4%) patients screened “positive” for suicide risk and received further evaluation. No patient had acute suicidal thoughts or required an observational monitor. 87% of patients reported feeling comfortable with screening; 81% of patients, 75% of nurses, and 100% of social workers agreed that all patients in hospitals should be screened for suicide risk. asQ`em study results: 140 patients participated in the research study, yielding a 4% positive rate for suicide risk requiring further evaluation.

Conclusions/Implications: Hospitals are important places to identify people at risk for suicide. However, clinicians require population and site-specific screening tools to reliably capture those at highest risk.  Screening medically ill adult inpatients for suicide risk is an important component of good clinical practice. However, validated screening tools are lacking.  The development of a rapid screening tool to be used by non-behavioral clinicians at the bedside will allow hospitals to identify those most in need as well as to meet JC’s standards. Working closely with members of multidisciplinary care teams, social workers should position themselves to participate in the evaluation and management of medically ill patients who are at risk for suicide. Results from our experience in both the asQ`em QIP and research study will inform suicide screening implementation in a hospital setting.