Streamlining Suicide Risk Screening and Comprehensive Evaluation Across Inpatient Mental Health Admissions in a Tier 1A VA Medical Center

Kelly M. Klein, PhD

VA Boston Healthcare System
Streamlining Suicide Risk Screening and Comprehensive Evaluation Across Inpatient Mental Health Admissions in a Tier 1A VA Medical Center

Scientific Abstract

Background: Inpatient mental health services at VA Boston Healthcare System admits Veterans through multiple triage avenues to two acute psychiatry units. Thus, initial suicide risk screening and identification of which Veterans need further risk evaluation has presented a significant challenge given the number of Veterans served and the number of providers from different disciplines involved in the admission process. Our inpatient team noticed several inconsistencies in this process, which resulted in a quality improvement project. Our project aims included: a) determine how frequently suicide risk screening was administered during admission and the consistency of findings across these multiple screenings, b) understand the timeframe in which follow-up suicide risk evaluations were conducted based on initial screening results, and c) understand factors influencing completion of updated risk evaluations at discharge.

Methods: The present study utilized a sample of Veterans for whom a comprehensive suicide risk evaluation was completed during their psychiatric hospitalization between January 1, 2020 and August 31, 2020 (N= 395 Veterans). A subset of these Veterans (N=56) who were admitted between July-August 2020 were used to investigate the aim around redundancy of suicide risk screening at admission.

Results: Veterans are repeatedly rescreened for suicide risk during the psychiatric admission process, sometimes up to 6 times, but typically between 3-4 times. Suicide risk screening results were often inconsistent (77%) across providers. The data suggests that there is a need for progress improvement in reaching a quick turnaround time for follow-up suicide risk evaluation at admission after an initial positive screening. Discharge suicide risk evaluation compliance increased with provider education, but also demonstrated continued room for improvement in this metric.

Conclusions: Our research highlights ongoing efforts to continue streamlining our process of risk assessment in an acute inpatient setting where suicide risk is managed by interdisciplinary providers in the context of mental health crises, substance abuse, and many other psychosocial factors.

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research Areas

Authors

Kelly M. Klein, PhD, Micaela Costa, LICSW, Fe Erlita Festin, MD