A Quality Improvement Initiative to Reduce Safety Events Among Adolescents Hospitalized After a Suicide Attempt.

Abstract

Self-harm among adolescents is a common problem, resulting in large numbers of patients admitted for medical stabilization after a suicide attempt. Because of limited mental health resources, these high-risk patients remain in inpatient settings once medically stabilized until psychiatric placement can be arranged. During this time, patients are at risk for safety events, including self-harm and elopement. Using quality improvement (QI) methodology, we aimed to reduce the frequency of significant safety events (SSEs) in this population by targeting modifiable risk factors and standardizing care. This was a QI study conducted at a medium-sized academic center. Key interventions included the development of the Pediatric Behavioral Health Safety Protocol, standardization of the patient safety search, and implementation of a daily Safety Huddle. Process measures were selected as metrics of use and adherence to the newly developed protocol. The rate of SSEs per 100 patient days was the primary outcome measure. There were 224 patients included in our study: 53 in the preimplementation and 171 in the postimplementation groups. Use of the Pediatric Behavioral Health Safety Protocol increased to 91.8% after implementation. The rate of SSEs per 100 patient days decreased from an average of 2.7 events per 100 patient days in the preimplementation period to 0.17 events per 100 patient days in the postimplementation period. The use of QI methodology to improve safety for adolescents admitted after a suicide attempt led to a substantial and sustainable reduction in the rate of SSEs at our institution.