Implementation of Columbia Suicide Severity Rating Scale (C-SSRS) as a Universal Suicide Risk Screening tool in a High Volume Emergency Department

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.

Keywords:

• C-SSRS
• emergency
• suicide
• screening
• universal

DISCLOSURE STATEMENT

None of the authors have any financial interests or benefits to disclose.

AUTHOR NOTES

Scott Syndergaard, Cape Fear Valley Health Emergency Medicine Residency, Campbell University School of Medicine, Fayetteville, NC, USA. Judith Borger, Cape Fear Valley Health Emergency Medicine Residency, Campbell University School of Medicine, Fayetteville, NC, USA. Scott Klenzak, Cape Fear Valley Health Psychiatry Residency, Campbell University School of Medicine, Fayetteville, NC, USA. Anthony Grello, Cape Fear Valley Health Emergency Medicine Residency, Campbell University School of Medicine, Fayetteville, NC, USA and Ashley Adams, The Geneva Foundation, Tacoma, WA, USA.