Vermont: Preventing Suicides with Emergency Department Screenings
In Vermont, suicide is a serious and growing public health threat for young people. From 2010 to 2014, suicide rates for Vermonters aged 10–24 years increased by 27%, with a yearly average of 1,200 emergency department (ED) visits for self-directed violence. This figure includes a range of violent behaviors, such as suicidal thoughts, drug poisonings and acts of fatal and nonfatal suicidal behavior. CDC research suggests that people with mental healthcare coverage and access to quality care have fewer risk factors for suicide and may be less likely to attempt suicide. The Vermont Department of Health (VDH) used a portion of its Preventive Health and Health Services (PHHS) Block Grant funds to use proven suicide prevention strategies, such as screening, assessment, and early intervention, in hospital EDs.
VDH joined forces with Northwestern Medical Center and established a quality improvement team to set up suicide risk screening and service referrals as a possible standard practice in the ED. Hospital managers and decision makers agreed to add suicide risk questions to the current ED tool used for substance- and alcohol-abuse screening.
The quality improvement team completed five test cycles and looked at various ways to 1) conduct suicide risk screenings, 2) document screening and referral results, 3) determine how screening results could be entered into the hospital’s electronic health records, and 4) reduce patient wait times for medical staff and an on-site crisis counselor. PHHS Block Grant funds supporte a team assistant to document ED processes, summarize quality improvement data, and provide accurate medical codes for suicidal thoughts and behaviors.
In the first 5 months of the pilot, VDH and Northwestern Medical Center screened 310 patients for suicide risk in the ED. Of these 310 people, 18 were found to be at risk for suicide, 2 refused to participate, and 1 was transferred to another hospital. Of the 15 patients who agreed to talk with the counselor, 8 were referred for services, 5 were already receiving services, and 5 refused further help.
Lessons learned for the next phase include the importance of 1) having an assistant to help hospitals pull and analyze medical charts, which is a potential barrier for ED participation, 2) training clinicians to use correct language in discharge summaries for consistent medical diagnosis coding, and 3) building relationships with hospital leaders.
The PHHS Block Grant is helping Vermont apply proven and systematic ways to prevent suicides.
Story year: 2017