PMH31 Universal Screening for Suicidal Thoughts and Behaviors in a Large Healthcare System's Hospital and Emergency Departments

Abstract

The Joint Commission recently revised its National Patient Safety Goal requirements to include standardizing suicide screening. Sutter Health launched system-wide standardized use of the Columbia Suicide Severity Rating Scale (C-SSRS) in acute care facilities in July 2019. Describe and compare characteristics of adult patients screening positive for suicidal thoughts or behaviors (STB) including those with major depressive disorder (MDD). Electronic health record-based observational cohort study describing and comparing sociodemographic and clinical characteristics of adult patients screening positive for STB (7/1/2019-10/4/2020), including those with MDD. MDD+STB were compared to those with STB without MDD (STB-MDD) and on risk categories (no risk v any risk). Wilcoxon rank-sum tests for continuous variables and χ2 tests for categorical variables were used. Results reported are statistically significant at 0.05. 410,302/478,143 (85.8%) of adults were screened by C-SSRS, 8,416 (2.05%) had STB, 914 (10.9%) had MDD+STB, 7,502 (89.1%) had STB without MDD. Of those with STB, 3,278 (38.9%) were low risk, 1,314 (15.6%) moderate risk, and 3,824 (45.4%) high risk. Any risk vs no risk: males (46.6% v 42.3%), White (55.5% v 47.9%), mean age 41.6 v 50.3 years, homeless in last 12 months (12.0% v 2.5%), index encounter Psych unit (10.3% v 0.2%), mental health diagnoses (22.2% v 4.9%), MDD (10.9% v 1%). MDD+STB patients vs MDD-STB: mean age 38.8 v 41.9 years, female (58.6% v 52.8%), Asian (9.7% v 6.6%), income $75,000+ (45.5% v 34.0%), index encounters in Psych units (46.5% v 5.9%), substance abuse (12.1% v 3.9%), anxiety (16% v 2.2%) and documented prior suicidal ideation (3.7% v 0.5%). Screening for STB identified 2.05% with any STB and 10.9% with MDD+STB. Characteristics differed based on risk and MDD status. Highlighting demographic and clinical differences between these patient groups can guide efforts to provide mental health consultation and referrals.