Addressing Suicide Risk in Primary Care: Cost Savings Associated with Diverting Patients From Emergency Departments

Mancini, Kathryn J.; Myers, Brittany R.; Pajek, Julie; Ramirez, Lisa; Stancin, Terry

doi:10.1097/dbp.0000000000001141

Cited by 1 publication

(6 citation statements)

References 27 publications

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“…These findings counter common concerns from providers and families that suicide screening may be iatrogenic or lead to marked increases in ED utilization (32)(33)(34). This study replicated a previous finding that over 90% of screen-positive youth who received a same-day IBH consult were diverted from the ED on both the day of their positive screen and during the subsequent month (7). However, we found that youth with positive screens who did not receive sameday IBH were also diverted from the ED at high rates.…”

Section: Discussionsupporting

confidence: 88%

“…These results should be interpreted in the context of the broader roll-out of ASQ screening and systematic risk determination in the clinics under study. In contrast to Mancini and colleagues (7), who compared rates of IBH-associated ED diversion to a pre-IBH norm of referring all youth with positive screens to the ED, medical providers in our study did not refer all positive screens to the ED as a matter of course. Consistent with the U.S. National Strategy for Suicide Prevention (35), medical personnel in our clinic were trained in a secondary assessment process as part of implementing the ASQ.…”

Section: Discussioncontrasting

confidence: 72%

“…Evidence-based based guidelines for assessing and responding to suicide risk in pediatric settings exist (4), but primary care providers (PCPs) report significant barriers, including time pressures, lack of training, and limited resources for managing positive screens (5,6). When patients screen positive in primary care settings and providers do not have sufficient time or expertise to fully assess risk, youth with a wide range of risk may be referred to an emergency department (ED) out of an abundance of caution (7).…”

Section: Introductionmentioning

confidence: 99%

“…Given the apparent mismatch between the goals and resources available in the ED and the needs of youth with less than imminent suicide risk, accurately diverting lower-risk patients from the ED, while assuring an appropriate level of care, is a meaningful goal. In the case of primary care-based suicide risk screening, integrated behavioral health (IBH) services that incorporate mental health professionals into the risk assessment process have been proposed as a method to accomplish this goal (7,14). One promising study found that 93% of patients who screened positive for suicide risk were diverted from the ED following a consultation with a BH specialist, resulting in a considerable estimated cost-savings (7); however, that study was limited by lack of a comparison group and use of a depression screener with suboptimal sensitivity for detecting suicide risk (15).…”

Section: Introductionmentioning

confidence: 99%

“…In the case of primary care-based suicide risk screening, integrated behavioral health (IBH) services that incorporate mental health professionals into the risk assessment process have been proposed as a method to accomplish this goal (7,14). One promising study found that 93% of patients who screened positive for suicide risk were diverted from the ED following a consultation with a BH specialist, resulting in a considerable estimated cost-savings (7); however, that study was limited by lack of a comparison group and use of a depression screener with suboptimal sensitivity for detecting suicide risk (15). Further, that study focused only on ED visits that occurred the same day as suicide risk screening, so subsequent utilization of the ED and other healthcare, including follow-up mental health supports, was unknown.…”

Section: Introductionmentioning

confidence: 99%

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Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk

Wellen,

Wright,

Bickford

et al. 2023

Front. Psychiatry

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IntroductionUniversal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month.MethodsWe conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization.ResultsAmong the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities.DiscussionIn the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

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Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 72%