1. Suicide Prevention Pathway
Behavioral Health Service Line
Dr. Linda Lang
Chair Department Psychiatry

2. Why Screen Every Patient?
45%
10th
Risk of suicide attempt or death is highest within 30 days of discharge from an ED or inpatient psychiatric unit
of individuals who die by suicide were seen by their PCP within 1 month of death.
Leading cause of death in the US.
37%
70% of patients leaving ED after a suicide attempt never attend their first outpatient appointment
The Delaware suicide rate outpaced the National average from
Of people who died by suicide having visited an ED within a year of death, did not have a mental health or chemical dependency diagnosis

3. Why Screen Every Patient? CCHS Initial Assessments
For Inpatients, Every 3 Days a New
Patient Initially Indicates Risk
(Oct – Mar. 2017)

4. The Tool: Columbia-Suicide Severity Rating Scale (C-SSRS)
Who: Most CCHS patient encounters
When: At triage
Performed by: RN
Nationally recognized, validated screening tool
Provides 3 Levels of Risk

5. The Tool: Columbia-Suicide Severity Rating Scale (C-SSRS)
Low
Suicidal ideation – no intent or plan or recent self-directed injurious behavior
Moderate
Suicidal ideation – with method or injurious behavior within 1-12 months, but no intent or plan
High
Suicidal ideation – with intent or plan or injurious behavior within 1 month.

6. Pathway Suggestions for Care
3 levels of stratified risk to facilitate appropriate and standardized interventions
Low Risk
Moderate Risk
High Risk
Patient is safe for outpatient treatment
Provide patient/family education including Safety Planning and outpatient referrals; Communication Order will detail these items in ExitCare
Safety Companion and Psychiatric Consult not indicated
Patient may not be safe for discharge
Psychiatric Emergency Services (ED patients) should perform more detailed screen to determine level of risk
Consider Safety Companion, Precautions, Psych Consult
Patient is not safe for discharge
Safety Companion, Psychiatric Consult, Precautions automatically ordered by pathway

7. The Pathway in Powerchart
Pathway Indicator in the Physician’s Note

8. The Pathway in Powerchart
Pathway Indicator on Problem List

9. The Pathway in Powerchart
Suicide Screening in Form Browser (sorted by “Form”)
*Columbia-Suicide Severity Rating Scale comes in several different versions, including the Daily/Shift Screen seen here.

10. The Pathway in Powerchart
Suicide Risk Order as it appears in Order List
*Can appear as High, Moderate, or Low Risk
Suggested Patient Education appears as a Communicate to Nurse order

11. For more information contact. . .
Dr. Linda Lang, Chair of Department of Psychiatry Psychiatric Consult Line Suicide Prevention Pathway Document (under Behavioral Health)