Implementation Barriers Encountered During a Universal Suicide Screening Program in Pediatric Emergency Departments

Area of Science:

• Pediatric Emergency Medicine
• Mental Health Screening
• Quality Improvement Initiatives

Background:

• Universal suicide risk screening in pediatric emergency departments (PEDs) is crucial for identifying and managing suicidal behaviors.
• Understanding barriers to these screenings can enhance identification and management strategies.

Purpose of the Study:

• To assess barriers to a quality improvement initiative using a novel computerized adaptive test (CAT), the Kiddie-CAT, in two PEDs.
• To identify factors hindering the implementation of universal suicide risk screening.

Main Methods:

• Research assistants used ethnographic methods to document barriers encountered during screening shifts.
• Thematic content analysis categorized barriers by type (workflow, language, attitudes) and impact (general shift vs. individual dyad).
• Reasons for refusal and descriptive data were also collected.

Main Results:

• Workflow issues (22.9%) and language/comprehension challenges (28%) were primary individual screening barriers.
• Workflow issues constituted 48.2% of general shift barriers.
• Many barriers stemmed from limited integration, with research assistants, not clinical staff, conducting screenings.

Conclusions:

• Limited integration into clinical protocols and the COVID-19 pandemic impacted the initiative.
• Physician education and addressing workflow issues are essential for successful universal screening in PEDs.