Systematic Suicide Screening in a General Hospital Setting: Process and Initial Results

Andres J Pumariega; Kolin Good; Kelly Posner; Udema Millsaps; Barbara Romig; Debra Stavarski; Robert Rice; Mary Jo Gehret; Kevin Riley; Thomas E Wasser; Gayle Walsh; Heather Yarger

doi:10.4103/WSP.WSP_26_19

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ORIGINAL ARTICLE

Year : 2020 \| Volume : 2 \| Issue : 1 \| Page : 31-42

Systematic Suicide Screening in a General Hospital Setting: Process and Initial Results Andres J Pumariega¹, Kolin Good², Kelly Posner³, Udema Millsaps², Barbara Romig², Debra Stavarski², Robert Rice², Mary Jo Gehret², Kevin Riley², Thomas E Wasser⁴, Gayle Walsh², Heather Yarger⁵ ¹ Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Florida, Gainesville, FL, USA ² Department of Nursing, Psychiatry, and Information Management Systems, The Reading Hospital and Medical Center, Reading, PA, USA ³ Department of Psychiatry, Suicide Prevention Center, School of Medicine, Columbia University, New York, NY, USA ⁴ Complete Statistical Services, Macungie, PA, USA ⁵ Department of Psychology, University of Maryland, College Park MD, USA Correspondence Address: Prof. Andres J Pumariega Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Florida, Gainesville, FL USA Source of Support: None, Conflict of Interest: None DOI: 10.4103/WSP.WSP_26_19

Background: Suicide is one of the leading causes of death across all age groups globally and poses a significant public health burden. In response to the United States Joint Commission National Patient Safety Goals, a tertiary hospital in the Northeast U.S. developed a suicide risk assessment and response protocol, consisting of systematic screening of patients for suicidal ideation/behavior with a screening version of the Columbia Suicide Severity Rating Scale (C-SSRS) and a response algorithm based on risk levels derived from the screen. Methods: A total of 837 nurses were trained and 24,168 patients ages 12 and above were screened with the C-SSRS Screener. Results: Posttraining interrater reliability on the C-SSRS Screener definitions of ideation and behavior was high and independent of level of education or mental health experience. Of the patients screened, only 144 patients (0.93%) were in the highest risk category, and they were assigned patient safety monitors until a follow-up consultation. The highest risk levels from the C-SSRS Screener reasonably identified subsequent attempts at self-injurious behavior during hospitalization. Screening resulted in lower burden due to reduction in the rate of psychiatric consultations and one-to-one observation shifts. Conclusions: These findings suggest that a systematic screening and clinical response protocol using the C-SSRS Screener can potentially enhance the ability to identify suicide risk in the general hospital population and focus services on patients with the most need.



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