Pathway Background and Objectives
Suicide is a leading cause of death for youth between 10 and 24 years of age in the United States. Many youth who later die by suicide had a health care visit within months of their death, which led to the release of the Joint Commission’s National Patient Safety Goal (NPSG) 15.01.01. The goal of the NPSG 15.01.01 is to improve the identification of youth at risk for suicide, assess risk level, and improve the quality and safety of care while in healthcare settings. Expert consensus pathways were created and utilized suicide screening tools appropriate for pediatric settings.
This standardized pathway was first developed in 2019 in Connecticut Children’s Emergency Department and utilizes a validated tool, the Ask Suicide-Screening Questions (ASQ), administered by nursing staff for all ED patients that are 10 years and older, medically stable and developmentally appropriate. The ASQ has three possible results including negative, non-acute positive (yes to any of the first 4 questions) and acute positive (yes to the 5th question). For non-acute positive results, the provider staff administer the Columbia Brief suicide risk assessment to confirm risk and stratify risk level (low, moderate or high). After undergoing many revisions over the years, this pathway has administered over 100,000 screens, and has successfully identified that roughly 1 in 5 patients who visit our Emergency Department screen positive for risk of suicide. This pathway involves a daily multi-disciplinary collaboration between nursing staff, providers, and social work/psychiatry team members. Additionally, the pathway has been launched on Med Surg floors 6 and 7 with a slight modification for inclusion criteria. If the patient is medically unstable, then nursing staff will re-evaluate the patient every 4 hours until they are medically stable to answer the suicide screening questions.
The objectives of this pathway are to:
- Identify youth at risk for suicide within our pediatric emergency department and Med Surg floors 6 and 7
- Improve the safety of youth at-risk for suicide
- Connect patient’s to care after screening positive for suicide risk