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Analysis of Hospitals Switching From a “Danger to Self” Question to Universal Columbia‐Suicide Severity Rating Scale Screening: Impact on Screenings, Identification of Suicide Risk, and Documented Psychiatric Care
- Source :
- Psychiatric Research and Clinical Practice; June 2024, Vol. 6 Issue: 2 p51-60, 10p
- Publication Year :
- 2024
-
Abstract
- Sutter Health launched system‐wide general population standardized suicide screening with the Columbia‐Suicide Severity Rating Scale (C‐SSRS) screen (triage) version in 23 hospitals in 2019, replacing a one‐question “danger to self” (DTS) assessment. This study analyzed the impact of C‐SSRS implementation on screening rates, positive screenings, and documented psychiatric care within 90 days for all patients and a subgroup diagnosed with Major Depressive Disorder (MDD). Adults seen at hospitals in the pre‐period (July 1, 2017−June 30, 2019) and post‐period (July 1, 2019−December 31, 2020) were identified using electronic health records. Outcomes were compared using chi‐square statistics and interrupted time series (ITS) models. Pre‐period, 92.8% (740,984/798,653) of patients were screened by DTS versus 84.6% (504,015/595,915) by C‐SSRS in the post‐period. Positive screening rates were 1.5% pre‐period and 2.2% post‐period, and 9.2% pre‐period versus 10.8% post‐period for those with MDD. Among individuals with positive screenings, 64.0% (pre‐period) had documented follow‐up psychiatric care versus 52.5% post‐period and 66.4% of those with moderate or high‐risk. Among all patients seen there was an overall increase in documentation of psychiatric care within 90 days (0.87% pre‐ to 0.96% post‐period). ITS models revealed a 9.6% decline in screening, 1.3% increase in positive screenings, and 12.9% decline in documented psychiatric care following C‐SSRS implementation (all p< 0.01). Following implementation, there was meaningful increase in suicide risk identification, and an increase in the proportion of patients with documented psychiatric care. Observed relative declines in screening warrant future research examining opportunities and barriers to general population C‐SSRS use. Twenty‐three hospitals switched from using a “danger to self” (DTS) question among the adult general population to standardized suicide screening with the Columbia‐Suicide Severity Rating Scale (C‐SSRS).This change led to a decrease in the proportion of patients screened (92.8% to 84.6%) and a meaningful increase in rates of positive screening (with suicide risk) from 1.5% to 2.2%Among all patients seen there was an overall increase in patients with subsequent documentation of psychiatric care within 90 days (0.87% pre‐ to 0.96% post‐period).Among people screening positive for suicidality, there was a relative reduction in documented psychiatric care within 90 days from 64.0% to 52.5%, likely due to C‐SSRS identifying people with low risk suicidal ideation.Switching from the unvalidated “DTS” question to using the validated C‐SSRS resulted in successfully identifying more patients at risk for suicide and the appropriate level of care needed. Twenty‐three hospitals switched from using a “danger to self” (DTS) question among the adult general population to standardized suicide screening with the Columbia‐Suicide Severity Rating Scale (C‐SSRS). This change led to a decrease in the proportion of patients screened (92.8% to 84.6%) and a meaningful increase in rates of positive screening (with suicide risk) from 1.5% to 2.2% Among all patients seen there was an overall increase in patients with subsequent documentation of psychiatric care within 90 days (0.87% pre‐ to 0.96% post‐period). Among people screening positive for suicidality, there was a relative reduction in documented psychiatric care within 90 days from 64.0% to 52.5%, likely due to C‐SSRS identifying people with low risk suicidal ideation. Switching from the unvalidated “DTS” question to using the validated C‐SSRS resulted in successfully identifying more patients at risk for suicide and the appropriate level of care needed.
Details
- Language :
- English
- ISSN :
- 25755609 and 25755609
- Volume :
- 6
- Issue :
- 2
- Database :
- Supplemental Index
- Journal :
- Psychiatric Research and Clinical Practice
- Publication Type :
- Periodical
- Accession number :
- ejs66556439
- Full Text :
- https://doi.org/10.1176/appi.prcp.20230068