Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines.
Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines.
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DOI：
10.1542/hpeds.2020-0039
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发表时间：
2020-10-01
影响因子：
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通讯作者：
Robb, Adelaide S
中科院分区：
文献类型：
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作者：
Latif, Finza;Patel, Shilpa;Robb, Adelaide S
目的：经联合委员会(TJC)认证的医院现在被要求使用有效的筛查工具和标准化方法来评估所有行为健康患者的自杀风险。本研究的目的是(1)在一家大型三级儿童医院的儿科急诊科(ED)和门诊行为健康诊所实施符合TJC的自杀风险筛查和评估流程；(2)描述这一人群与自杀风险相关的特征；(3)报告这一新流程对ED住院时间(LOS)的影响。每月对筛查和评估的遵从性进行审查。描述性统计被用来定义研究人群，多变量回归被用来对与高自杀风险和出院相关的因素进行建模。结果：急诊科的平均筛查依从率为83%，门诊为65%。教育署对标准化评估的遵从率由实施前的0%上升至实施后的88%。分析显示，急症室72%的行为健康患者和行为健康门诊18%的患者具有正自杀风险。埃德·洛斯没有增加。大部分高危患者在评估后出院。结论：在不增加ED LOS的情况下，在急诊科和门诊行为健康门诊实施符合TJC的自杀风险筛查和评估流程。
OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children's hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS).METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation.RESULTS: Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment.CONCLUSIONS: A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.