079 - Elusive Suicidality: A descriptive quality initiative on improving suicide screening practices to identify missed opportunities in an urban adolescent health clinic.

Publication Number: 79.4904

Eesha Farooqi, University of Texas Southwestern Medical School, Irving, TX, United States; Jenny KR. Francis, University of Texas Southwestern Medical Center, Dallas, TX, United States; M. Brett Cooper, University of Texas Southwestern Medical School, Plano, TX, United States; Erik Su, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Youth suicide remains a leading cause of death in the pediatric population. Studies show that patients were seen by a physician within 1 month of their death.

Objective: To assess the implementation of the Ask-Suicide-Screening Questions (ASQ) tool to our adolescent and young adult (AYA) patients, in addition to the standard Patient Health Questionnaire-A (PHQ9) to compare risk-of-suicide identified with the standard screening alone versus with the ASQ combined.

Design/Methods: We performed a chart review of previous AYA patients over 6-months (July 2023 to December 2023) that included PHQ9 scores and the response to question #9 (Q9), indicating thoughts of suicide. Then, we implemented the ASQ screening tool in the flow of patient intake surveys to all subsequent AYA patient visits. We queried the electronic health record to collect 6-months (January 2024-June 2024) of data, including 1) total PHQ9 scores, 2) Q9 response, 3) total ASQ score and 4) ASQ question #5 (Q5) response (acute suicide risk). A clinic safety protocol was implemented for any patient that marked “yes” to acute thoughts of suicide on Q5. We used descriptive frequencies and proportions to report the data.

Results: A total of 761 unique patients were queried. We excluded 53 patients with incomplete PHQ9 surveys, resulting in 708 final patients, of which 178 patients completed the PHQ9-only and 530 patients completed the PHQ9 and ASQ. Of the patients who completed a PHQ9-only, there were 104 normal PHQ9s (total score < 5), of which 2 marked Q9 positive (2% of patients with normal PHQ9 scores being at risk for suicide). There were 74 abnormal PHQ9s, of which 15 marked Q9 positive (20% of patients with abnormal PHQ9 scores being at risk for suicide). Of the patients who completed both a PHQ9 and ASQ, there were 303 normal PHQ9s and 227 abnormal PHQ9s. Of the 303 normal PHQ9s, there were no patients that marked Q9 positive. In contrast, 8 of these patients had an abnormal ASQ, picking up 2.6% patients with normal PHQ9 scores yet at risk for suicide and missed with the PHQ9 alone. Of the 227 abnormal PHQ9s, 179 patients marked Q9 negative. In contrast, 25 of these patients had an abnormal ASQ, picking up 11% of patients with abnormal PHQ9 at risk for suicide and missed with the PHQ9 alone.

Conclusion(s): Based on initial results, a total of 13.6% patients that were at risk for suicide yet missed with using the PHQ9 alone. By including the ASQ tool in clinic, providers can identify more patients who are at risk for suicide opening multiple avenues to approach the conversations of suicidality, provide resources, and maintain close follow-up.