P3A042: Improving Rates of Adolescent Suicide Risk Screening in a Primary Pediatric Clinic, a Quality Improvement Project

Purpose/Objectives: During recent times, adolescents have had increasing mental health needs, including rising rates of suicidal ideation. In our primary care pediatric clinic, while pediatricians were completing a standardized depression screen, no additional risk screens were administered if a patient expressed positive suicidal ideation.

We sought to implement the ASQ (Ask Suicide Questions) screening tool, with the goal of increasing the rate of suicide risk screening by 20%. Additionally, we wanted to survey our clinicians around their comfort in identifying and managing patients with suicidal ideation. We also wanted to assess our clinicians’ attitudes toward electronic health record (EHR) tools for mental health screening.

Design/Methods: Baseline analyses were performed on 746 adolescents, ages 12 to 19, seen in an urban pediatric practice between August and November 2022. Twelve clinicians completed a baseline provider survey prior to project implementation. For our intervention, the PHQ-9A and ASQ tools were built with decision-support logic into the EHR. Between December and March 2023, follow-up analyses were conducted on 554 patients. The follow-up clinician survey was completed post-intervention by eleven respondents.

Results: At baseline, 4.5% of patients who completed the depression screen had a positive response to the suicidal ideation question. Of those with a positive response, 67.6% had documentation in the provider’s note, acknowledging this finding. 8.8% of those with a positive response had an additional suicide risk screening completed. After implementing the new PHQ-9A/ASQ workflow, follow-up analyses showed that 10% of patients had a positive response to the question regarding thoughts of suicide/self-harm. Of the patients who expressed suicidal ideation on the PHQ-9A, 95% had the additional ASQ risk screen completed.

The baseline clinician survey showed that while 100% of providers felt comfortable identifying patients with suicidal ideation, only 50% felt comfortable assessing suicide risk. Pre-intervention, 8% of respondents felt that current EHR tools supported medical-decision making around suicidal ideation. Post-intervention, 100% of clinicians respsonded that they felt comfortable both identifying patients with suicidal ideation and assessing suicide risk. After implementation of the ASQ tool, 100% of clinicians felt that the EHR supported medical-decision making.

Conclusion/Discussion: In three months following implementation of the new PHQ-9A and ASQ workflow, we saw a marked increase in the number of patients who had further suicide risk assessments completed. Providers also felt more comfortable assessing suicide risk, and had more positive attitudes towards the EHR. Implementing clinician-informed EHR tools can potentially help to reduce documentation burden and improve workflows when caring for complex patients. For our next steps, we plan to build a clinician-friendly safety plan for high-risk patients, and will evaluate clinicians’ attitudes towards the new workflow.