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Keywords

Health professions education, Quality improvement report

Abstract

Suicide is currently the second leading cause of death among adolescents in the United States and the third leading cause of death in this age group worldwide.1,2 Suicide prevention is understandably a growing focus in pediatrics. Currently, at the Children’s Hospital Outpatient Clinic, that is staffed by pediatric resident physicians, suicidal ideation is screened for using a PHQ-9 screen. However, at the time this study was initiated and completed, the TEEN screen was utilized. After the screening is performed, regardless of type, it is up to the provider to address these findings in a safe and effective manner. The goal of this quality improvement project was to develop and implement a suicide safety plan for patients who express suicidal ideation and to increase resident’s comfortability when discussing suicide prevention with patients. Google Forms were used to survey pediatric residents to obtain preliminary data, as well as data following each PDSA cycle. For our first PDSA cycle, the initial suicide safety plan was introduced. After feedback provided by residents, the safety plan was then converted to a flowsheet style format for the second PDSA cycle. Both formats were then compared to assess the use and associated resident comfort. Suicidal ideation is a prevalent issue in pediatrics as evidenced by our preliminary data which reported that out of 30 residents, 26 (86.7%) have encountered a patient with suicidal ideation. However, the percentage of residents who rated themselves a 5, or “very comfortable”, on a scale of 1-5 with 1 being “not comfortable at all,” when discussing suicide with patients was just 13.3%. With each phase of our study, the percentage of residents who rated themselves a 5, or “very comfortable” increased from 40.9% to 50%, respectively. Our data indicates that the implementation of such a plan did increase resident comfort by acting as a template for which to guide discussion with patients and their families for a very important topic in adolescent health.

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