Abstract

Objective

To examine clinical and demographic parameters with regards to efficacy, resource utilization, and clinician burden associated with implementation of universal suicide screening by Columbia Suicide Severity Rating Scale (C-SSRS) in a single high-volume emergency department.

Methods

This retrospective cohort study, performed via chart review, included 10,197 adult patients seen in the emergency department over two specific time frames (4935 pre- and 5262 post-implementation of the screening tool). All visits with psychiatry consultation underwent further chart review (172 pre- and 217 post-) to compare number, length of stay (LOS) and demographics for psychiatric evaluations pre- and post- use of C-SSRS screening.

Results

Both groups were predominantly male with previous psychiatric diagnoses. Within the post-screening group, individuals tended to be older with lower likelihood of previously diagnosed psychiatric illness. No significant differences were seen in gender, psychiatric diagnosis, or outpatient psychiatric treatment. Incidence of psychiatric evaluation was slightly higher post-screening (18%) without meeting statistical significance, with more patients discharged home in the post- cohort. LOS was slightly lower after implementation of C-SSRS, without reaching statistical significance.

Conclusions

Implementation of universal screening showed increased demand for psychiatric evaluations, without meeting clinical significance in this limited analysis. Although there were slightly more psychiatric evaluations, more patients were discharged to home. LOS showed no statistical increase, even trending toward shorter duration for patients screened to be evaluated by psychiatry. Based on these results, efficient suicide screening may help identify at-risk individuals without overwhelming psychiatric resources or causing unnecessary increase in LOS.

• Highlights

• Rapid identification of suicide risk is important in an emergency department environment.

• Universal suicide screening has limitations, with concerns for emergency department resources.

• Use of C-SSRS for universal screening does not show significant burden to this department.

中文翻译：

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实施哥伦比亚自杀严重程度评定量表 (C-SSRS) 作为大容量急诊科的通用自杀风险筛查工具

摘要

客观的

旨在检查与在单个高容量急诊科中使用哥伦比亚自杀严重程度评定量表 (C-SSRS) 实施普遍自杀筛查相关的疗效、资源利用和临床医生负担的临床和人口统计学参数。

方法

这项通过图表审查进行的回顾性队列研究包括在两个特定时间范围内在急诊科就诊的 10,197 名成年患者（筛查工具实施前 4935 名，筛查工具实施后 5262 名）。所有接受精神病学咨询的就诊都进行了进一步的图表审查（前 172 次，后 217 次），以比较使用 C-SSRS 筛查前后进行精神病学评估的人数、住院时间 (LOS) 和人口统计数据。

结果

两组都主要是男性，之前有过精神病诊断。在筛查后组中，个体往往年龄较大，先前诊断出精神疾病的可能性较低。在性别、精神病诊断或门诊精神病治疗方面没有显着差异。精神病学评估的发生率在筛查后略高 (18%)，但没有达到统计学显着性，更多的患者在后队列中出院回家。实施 C-SSRS 后 LOS 略有降低，但未达到统计学意义。

结论

普遍筛查的实施表明对精神病学评估的需求增加，但在这一有限的分析中没有达到临床意义。尽管精神病学评估略多，但更多患者出院回家。LOS 没有显示出统计上的增加，甚至倾向于缩短接受精神病学评估的筛查患者的持续时间。基于这些结果，有效的自杀筛查可能有助于识别有风险的个体，而不会压倒精神科资源或导致不必要的 LOS 增加。

• 强调

• 在急诊科环境中，快速识别自杀风险很重要。

• 普遍的自杀筛查有局限性，担心急诊科资源。

• 使用 C-SSRS 进行普遍筛查并未对该部门造成重大负担。