Between 2009 and 2017, rates of major depressive episodes increased 63% among young adults 18 to 25, a rate change accompanied by an increase in suicide-related outcomes. In the Emergency Departments at Arkansas Children’s Hospital in Little Rock and Arkansas Children’s Northwest in Springdale, which opened in 2018, clinicians use tools in Epic to identify patients who might be experiencing depressive episodes but have no known behavioral health risk indicators, so they can get the help they need. In the first year and a half following implementation of the tool, the screening identified 1,184 patients in need of behavioral health precautions, 44% of whom were deemed at risk for suicide and received counseling and other support.
A nurse completes a behavioral health screen for every patient over the age of 2, no matter what complaint brought the patient to the ED. For patients over the age of 10, the standard Ask Suicide-Screening Questions from the National Institute of Mental Healthcare are included in the behavioral health screen. When patients answer yes to any of the standard Ask Suicide-Screening Questions from the National Institute of Mental Health, clinical decision support automatically suggests they be seen by social services. Staff are assigned to observe these patients and to answer additional questions that can prompt order suggestions for things like placement in a secure room and special requests for nutritional services. At twice-daily meetings, staff discuss patients’ progress and other possible interventions using a report in Epic that shows patients currently under observation.
“We stopped patients from harming themselves who might not have been identified without this tool,” said Emily Huffman, a nurse at Arkansas Children’s and a clinical project manager for quality improvement. “Nurses have embraced this tool.”