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Suicidality Screening: Ensuring Providers Do Not Miss Adolescents at High Risk through Clinical Decision Support.

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This study improved electronic health record alerts for adolescent depression and suicide risk screening. Enhanced clinical decision support ensures high-risk youth receive timely interventions, improving patient care.

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Area of Science:

  • Adolescent psychiatry
  • Clinical informatics
  • Public health

Background:

  • Major depression and suicide risk in adolescents are significant public health concerns.
  • Effective screening and clinical decision support (CDS) are crucial for timely intervention.
  • Leveraging electronic health records (EHR) can optimize care delivery for at-risk youth.

Purpose of the Study:

  • To enhance notification systems for positive adolescent depression and suicide risk screening results.
  • To design and optimize CDS alerts for severe depression and acute lethality.
  • To improve EHR user visibility and reduce missed interventions.

Main Methods:

  • Implemented iterative, interruptive CDS alerts within EHR for patients aged 12-20 years.
  • Utilized Patient Health Questionnaire (PHQ) and Ask Suicide-Screening Questions (ASQ) for screening.
  • Revised alerts based on user feedback, incorporating separate notifications for depression and suicide risk, and schedule icons.

Main Results:

  • Over 76,000 visits were included, with screening completion rates increasing over time.
  • Alerts were triggered for 2,355 non-acute and 411 acute positive screenings.
  • Alert acknowledgment rates ranged from 63-96%, with cancellation rates from 6-70% across provider types.

Conclusions:

  • Iterative improvements in CDS alerts and workflow integration enhance notification and visibility.
  • Optimized EHR-based decision support effectively addresses positive depression and suicidality screenings in adolescents.
  • This approach supports timely and appropriate interventions for high-risk youth.