Suicide Risk Screening in Pediatric Primary Care: A Quality Improvement Collaborative Approach

Pediatric primary care settings are ideal venues for detecting suicide risk. This quality improvement project (QIP) aimed to improve suicide risk screening adherence by 25% within a pediatric primary care network. Secondary aims were to increase providers' comfort in addressing suicidal ideation with their patients, as well as improve management of suicide risk within the office setting.

Quality Through Technology and Innovation in Pediatrics (QTIP-housed at the South Carolina Department of Health and Human Services [SCDHHS]), a quality improvement collaborative group, helped implement suicide prevention in 28 South Carolina primary care settings. QTIP trained clinicians over 18 months from January 2020 to July 2021, during which each practice completed 10 monthly chart audits. Providers completed an annual survey regarding their comfort level in managing suicidal behavior in June 2020 and 2021.

Suicide risk screening adherence increased 25.1% from 62.3% at month 1 to 87.4% at month 18. Chart audits revealed that 77.8% of patients (3691/4741) were screened for suicide risk, with 3.2% (N = 119/3691) screening positive and 0.4% (N = 14/3691) requiring emergency care. Of the nonacute positive screens, 88.2% (N = 105/119) were referred to outpatient behavioral health care and 90.8% (N = 108/119) received in-office interventions. Clinician satisfaction increased 57.7% over the course of the QI implementation. Exactly 69.6% (N = 16) of practices modified their QIP during the study period based on clinician feedback.

Suicide prevention strategies were feasibly implemented within a large primary care network. Repeated education, best practice clinical skills training, and quality improvement interventions were key to fostering change.