Rady Children's Hospital is screening all patients over the age of 12 in the emergency department.
With the number of behavioral health visits to the emergency department (ED) rising significantly, staff members at Rady Children's Hospital in San Diego, prioritized the goal of standardizing screening of patients over the age of 12 for at-risk behaviors of depression and suicide. Jason Malia, M.H.A., R.N., manages the ED at Rady Children's and explained the hospital's improvement process at the 2018 Quality and Safety in Children's Health Conference.
Malia was part of a hospital committee that identified evidence-based tools, educated staff members and rolled out the tools in the ED. The hospital records about 3,000 visits a year for mental health care; that's about 3 percent of yearly visits. "It's staggering to think that half of the patients who hurt themselves or commit suicide have been to a hospital or clinic to get help, maybe hoping someone recognized they needed help," Malia says. "We chose two screening tools because they were tried and tested."
Rady Children's uses the PHQ-9 patient health questionnaire consisting of two questions:
- Have you in the past two weeks felt down, depressed or hopeless?
- Have you had little interest or pleasure in doing things?
"The hospital took a strong approach to screen everybody," Malia says. "We wanted to intervene on anybody who was positive for any sort of screening results."
If a patient had a positive result, staff then move to the Columbia Suicide Severity Rating Scale (C-SSRS). Clinicians can rely on a computer-generated intervention plan when they encounter a child with moderate to severe risks for depression or suicide.
At the request of providers, their intervention plan includes connecting at-risk children and their families to resources and a follow-up call by hospital representatives. Executive and board support helped make the plan a priority, and the hospital has a 98 percent follow-up rate.
Malia also offered an overview of the hospital's formula for success:
- Engage IT to make sure the question and prompt process works smoothly and consistently.
- Create a multidisciplinary team so everyone is at the table.
- Know it won't be perfect. The team members at Rady Children's added a hard stop when they realized it was necessary to make sure the screenings were completed.
- It's a lot of hard work, but you can do it.
- Quell fears by letting everyone know their feelings are heard.
- Follow-up with patients. Just screening patients will not help them.
In addition to screening patients in the ED, Rady Children's is on the forefront of care with the creation of the Behavioral Health Urgent Care Center. The center has been operating for about a year, offering walk-ins or appointments. "We've had people drive 120 miles to our center," says Donald Kearns, M.D., president and CEO at Rady Children's.
"At some point, better behavioral health care becomes a national movement," Kearns says. "This is something we all think is incredibly important in our communities, and how we deal with these kids is the biggest challenge we have every day. I don't have a great answer, but we found an answer in urgent care."
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