Utility of an Integrated Electronic Suicide Alert System in a Psychiatric Hospital

Management of suicide-related behaviors in a hospital is challenging. This article (1) describes integration of an electronic suicide risk notification system to improve assessment of psychiatric inpatients, (2) details the manner in which these alerts complement standard of care, and (3) provides support of using aggregate data to inform administrative decision-making. Complementing routine clinical care and under the supervision of an assessment coordinator, adult inpatients at a specialty psychiatric hospital complete a computerized battery of outcome assessments throughout the course of their hospitalization. A critical-item response notification system for suicide-related behaviors was implemented within the larger, assessment architecture, sending an alert e-mail to unit staff if patients endorsed suicidal ideation on any 1 of 6 critical items. Analysis of aggregate data over a 19-month period reveal a linear trend of increasing rate of suicide alerts from October 2012 to April 2013 (Phase A) with a stabilization at the heightened level from July 2013 to April 2014 (Phase B), R = 0.697, P = .007. Findings suggest that more nuanced training in the management of suicide-related behavior may be necessary and that traditional approaches to staffing may need to accommodate patient acuity. The communication innovation of this system is in line with the Joint Commission's emphasis on designing and implementing patient-centered systems that enhance quality of care, including improved safety.

[1]  Barbara Stanley,et al.  The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. , 2011, The American journal of psychiatry.

[2]  L. Aiken,et al.  Nurse Burnout and Patient Satisfaction , 2004, Medical care.

[3]  J. Neily,et al.  Actions and implementation strategies to reduce suicidal events in the Veterans Health Administration. , 2006, Joint Commission journal on quality and patient safety.

[4]  M. Wolfersdorf.  Suicide Among Psychiatric Inpatients , 2008 .

[5]  T. Ellis,et al.  Supporting a Psychiatric Hospital Culture of Safety , 2012, Journal of the American Psychiatric Nurses Association.

[6]  J. Borckardt,et al.  Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital. , 2011, Psychiatric services.

[7]  R. Spitzer,et al.  The PHQ-9: A new depression diagnostic and severity measure , 2002 .

[8]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[9]  Martin McKee,et al.  Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States , 2012, BMJ : British Medical Journal.

[10]  D. Hackney,et al.  Formal observations and engagement: a discussion paper. , 2002, Journal of psychiatric and mental health nursing.

[11]  Jon G. Allen,et al.  Integrating outcomes assessment and research into clinical care in inpatient adult psychiatric treatment. , 2009, Bulletin of the Menninger Clinic.

[12]  S. Bloom.  Creating Sanctuary: Toward the Evolution of Sane Societies, Revised Edition , 2013 .

[13]  D. Jacobs.  Managing Suicidal Risk: A Collaborative Approach , 2007 .

[14]  J. Borckardt,et al.  Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective. , 2014, Psychiatric services.

[15]  Michael Miller.  The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors , 2000 .

[16]  Ronald C Kessler,et al.  The economic burden of depression in the United States: how did it change between 1990 and 2000? , 2003, The Journal of clinical psychiatry.

[17]  J. Cutcliffe,et al.  Considering the care of the suicidal client and the case for 'engagement and inspiring hope' or 'observations'. , 2002, Journal of psychiatric and mental health nursing.

[18]  Jon G. Allen,et al.  Collaborative assessment and management of suicidality in an inpatient setting: results of a pilot study. , 2012, Psychotherapy.

[19]  M. D. Murphy,et al.  Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. , 2008, The American psychologist.

[20]  Richard Ray,et al.  The evolution of practice changes in the use of special observations. , 2011, Archives of psychiatric nursing.

[21]  B. Wright.  The international handbook of suicide and attempted suicide , 2003 .

[22]  M. Hayter,et al.  Alternative approaches to 'enhanced observations' in acute inpatient mental health care: a review of the literature. , 2010, Journal of psychiatric and mental health nursing.

[23]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.