Promoting Documentation of Suicidality in a Family Medicine Residency Clinic

Abstract

Background and Objectives: Careful assessment of depression and suicidality are important given their prevalence and consequences for quality of life. Our study evaluated the impact of an educational intervention in a family medicine residency clinic on rates of provider documentation regarding suicidality. Methods: We offered two brief workshops to our clinic staff and created two standardized charting templates to empower and educate providers. One template used with the patient during the clinic visit elicited key factors (eg, plan, intent, barriers) and offered treatment plan options. The second template included supportive text and resources to include in the after-visit summary. A chart review was completed, examining 350 patient records in which the patient reported thoughts of death or suicide in the preceding 2 weeks on the Patient Health Questionnaire-9 ([PHQ-9], 150 over a 5-month baseline period, 150 in months 1 through 4 immediately following the workshops and template development, and 50 at follow-up months 7 through 8 following the intervention). We examined use of the templates and changes in rates of documentation of suicidality. Results: Rates of provider documentation of suicidality for patients who had expressed suicidal ideation on the PHQ-9 increased significantly from 57% at baseline to 78% in the postintervention phase; the rise persisted at follow-up. Rates of use of the assessment template were 58% (postintervention) and 49% (follow-up). Anecdotal provider feedback reflected appreciation of the templates for assessing and documenting challenging issues. Conclusions: Brief educational interventions were associated with improved rates of provider documentation of suicidality. The longer-term impact of the workshops and templates warrant further investigation.

A panorama of the medicolegal aspects of suicide assessments: integrating multiple vantage points in improving quality, safety, and risk management

“…This not only signifies a better assessment, practice, and care, but also leads to a less vulnerable psychiatrist in a court of law. Another study reviewed clinical notes and concluded that residents with better quality notes ultimately performed better assessments 40 . Many recommend extemporaneous assessment at the time of discharge, as a discharge summary written even 1 hour after a patient commits suicide, is considered a worthless document.…”

“…Another study reviewed clinical notes and concluded that residents with better quality notes ultimately performed better assessments. 40 Many recommend extemporaneous assessment at the time of discharge, as a discharge summary written even 1 hour after a patient commits suicide, is considered a worthless document. It is also important to carefully document the thorough process leading to the clinical decision, which helps not only in court cases, but also in the continuity of care.…”

Suicide in primary care: How to screen and intervene

“…Training and follow-up reminders regarding adequate documentation of suicide assessment is known to improve quality of documentation. 24 The documentation of the model helps the primary care physician in at least two significant ways. First, it improves patient safety by ensuring all components of the risk assessment are available for future use and accountability.…”

Improving Family Medicine Residents’ Confidence to Assess and Manage Psychiatric Crises in an Outpatient Clinic

“… 13 , 14 Some residencies have risen to this call by implementing trainings and workflow changes, such as workshops and standardized charting templates, finding significant benefit. 15 These studies document helpful interventions to consider when creating and implementing curricula; yet, they are limited in that they solely focus on suicidality and it cannot be concluded that this curricula is beneficial for other types of crises. This study helps fill this critically important literature gap by describing a brief training intervention and point-of-care resources that improved family medicine resident confidence in the outpatient assessment and management of all types of psychiatric crises.…”