Decreasing Self-Directed Violence after Inpatient Psychiatric Stays Using Evidence-Based Follow-Up Outreach

Suicide in the United States is becoming a public health crisis. According to the Centers for Disease Control and Prevention (CDC), the United States experienced a 28% increase in suicide between 2000 and 2015 (Stone et al., 2017). In a sentinel event alert published by the Joint Commission in 2016, suicide was identified as the 10th leading cause of death in the United States. Shockingly, “providers often do not detect the suicidal thoughts (also known as suicide ideation) of individuals (including children and adolescents) who eventually die by suicide, even though most of them receive health care services in the year prior to death” (Joint Commission, 2016). Further research into this increase has shown that within the first two weeks of discharge from an inpatient psychiatric stay, patients are most vulnerable to self-harm (Redding et al, 2017, Wise, 2014). As such, missed opportunities for healthcare providers to facilitate the transition of care to outpatient mental health treatment is the area that this project is targeting.
The project is designed to provide an evidence-based structure for these follow-up calls, standardizing the assessment questions, using a depression screening tool already embedded in the electronic medical record (EMR), as well as providing evidence-based interventions for staff to implement for those patients at the highest risk for self-harm. In addition to a telephone call note template that will provide for consistent data collection about barriers to care after discharge, the staff will administer the patient health questionnaire (PHQ-9), a depression screening tool currently embedded in the EMR, and administered upon discharge from the inpatient psychiatric units.

In closing, this project has the potential to strongly support the proposed post-discharge outreach program. This project, once implemented as part of the larger outreach program, will give the nurses guidance in their assessment of the patient’s needs during their transition from inpatient to the community. It will provide evidence-based interventions for patients found to be at high risk for self-directed violence. In addition, it will maximize the data collection functionality of the EMR, thus allowing for analysis to identify trends in barriers to care, which leadership can act upon. For example, if a patient attempts to fill a prescription that requires a prior authorization, this contact can allow staff to expedite this process, thereby removing the barrier to medication adherence. Using the data to solve the individual patient’s problem is useful, but adding in the ability to track barriers and outcomes will also demonstrate cost savings by reducing avoidable readmissions.