Improving Universal Suicide Risk Screening Rates at a Children's Hospital

Suicide is a leading cause of death among US youth. In hospital settings, screening for suicide risk enables assessment, brief interventions, and linkage to treatment. Our objective was to increase compliance with universal suicide risk screening for patients aged 10 years or older during acute care visits (to the emergency department [ED] and/or inpatient medical units) of a children's hospital from 27% to greater than or equal to 60% over 13 months.

Using quality improvement methodology, a multidisciplinary team implemented interventions to increase compliance with universal suicide risk screening for patients aged 10 years or older at an academic children's hospital from June 2022 to June 2023, followed by a 7-month sustainment period. Interventions included a clinical care guideline and clinical decision support tools embedded in the electronic health record (EHR). We measured compliance with administration of Ask Suicide-Screening Questions (ASQ) during eligible visits, overall and stratified by care area, and positivity rates.

During the intervention and sustainment periods, there were 18 435 and 10 257 acute care visits by patients aged 10 years or older, respectively. Screening compliance rates increased from 27% to 80% overall, from 17% to 80% in the ED, and from 55% to 76% in inpatient medical units. Of acute care visits with screening performed during the sustainment period, 8.6% had positive ASQ screening (6.9% nonimminent risk and 1.7% imminent risk).

Implementing a clinical care guideline, accompanied by EHR-integrated clinical decision support, increased compliance with suicide risk screening at a children's hospital. Screening positivity rates reflect mental health needs among children receiving acute care.