Background: Suicide is growing crisis in the United States and worldwide. Nearly one million people die by suicide each year. Suicide is one of the leading causes of death for all adolescents and young adults. The Centers for Disease Control (CDC) reported many states across the country have seen between an 18-58% increases in suicide rates from 1999 to 2016. The state of Utah is among the states with the highest rate of suicide during that time period. Many of these patients utilize the Emergency Department (ED) as a first line of care. The most common contributing factors of suicidal attempts include, relationship problems, crisis in the past or upcoming two weeks, problematic substance abuse, physical health problems, job or financial problems. Many patients that suffer from a mental health diagnosis, such as depression or anxiety will also be seen in the ED due to a suicidal ideation (SI). The first steo in preventing these acts is to properly identify those at risk for suicide, and providing proper referral. Since most of these individuals are presenting to the ED, it is of the upmost importance that these providers are properly equipped to identify these patients. The University of Columbia, in collaboration with other groups and accrediting bodies, constructed a universal screening tool called the Columbia Suicide Severity Rating Scale (C-SSRS). This tool was built to serve in many heathcare settings and has shown to be very successful in identifying those at risk for suicide. The C-SSRS has particularly shown that it can be used as a universal screening tool in the ED aiding providers in properly identifying suicide risk levels. Methods: The C-SSRS was documented using an Electronic Health Care Record (EHR). Nursing staff administered the C-SSRS tool to each patient that presented to the ED. Policy was modified to fit the C-SSRS triage criteria for low, moderate and high-risk evaluations. This policy change was approved by the forms committees. The project compared the number of false positives and true positives from the C-SSRS and confirmed these findings with the assessment of the licensed provider. A calculated Chi-square test/Fisher Exact Test provided the specificity and sensitivity of each scale. Findings: The result and findings of this project demonstrated a high sensitivity and specificity in the ED at St. Marks Hospital. During the 30-day study, 3618 patients were screened for suicidal ideation. Of those patients, 172 were found to be at risk for suicide ideation. Only four of those patients were found to have a false negative finding compared to provider documentation. Conclusion: The CSSRS accurately triaged and identified patients at risk of SI. A sample size of 3618 patients assessed is a very respectable sample for a 30 day window. Provider documentation correlated well with CSSRS assessment and P value was significant, giving staff a reliable and valid evidence-based tool for identifying suicidal ideation in the ED.
