Implementation of a Suicide Risk Screening Clinical Pathway in a Children's Hospital: A Feasibility Study

Area of Science:

• Pediatric emergency medicine
• Mental health screening
• Public health interventions

Background:

• Youth suicide is a critical global health issue.
• Evidence-based clinical pathways exist for suicide risk screening.
• Feasibility of implementing these pathways in real-world settings requires evaluation.

Purpose of the Study:

• To assess the feasibility of a hospital-wide youth suicide risk screening pathway implementation.
• To evaluate the execution, fidelity, resource utilization, and acceptability of the pathway.
• To address the gap in understanding the practical application of suicide risk screening tools.

Main Methods:

• A 3-tier youth suicide risk screening pathway using The Ask Suicide-Screening Questions (ASQ) was implemented.
• The study included patients aged 10–26 years in an urban academic pediatric hospital's ED and inpatient units.
• Retrospective review of implementation outcomes from January 1 to August 31, 2019, assessed feasibility metrics.

Main Results:

• 83% of eligible patient encounters completed the ASQ screen.
• 1% screened acute positive, 8% non-acute positive for suicide risk.
• Pathway fidelity was high (83% overall, 94% for acute positive screens), with strong provider support (65% nurses, 78% social workers).

Conclusions:

• A youth suicide risk screening pathway is feasible to implement in an urban academic pediatric hospital.
• The implementation did not overburden the healthcare system.
• The study demonstrates successful integration of suicide risk screening into routine pediatric care.