title: Ask suicide-screening questions to everyone in medical settings: the asQ'em Quality Improvement Project.
abstract: BACKGROUND
  Suicide in hospital settings is a frequently reported sentinel event to the Joint Commission (JC). Since 1995, over 1,000 inpatient deaths by suicide have been reported to the JC; 25% occurred in non-behavioral health settings. Lack of proper "assessment" was the leading root cause for 80% of hospital suicides. This paper describes the "Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ'em)" Quality Improvement Project. We aimed to pilot a suicide screening tool and determine feasibility of screening in terms of prevalence, impact on unit workflow, impact on mental health resources, and patient/nurse acceptance.
  
  
  METHODS
  We piloted the asQ'em two-item screening instrument that assesses suicidal thoughts and behaviors, designed specifically for nurses to administer to medical patients. Educational in-services were conducted. A convenience sample of adult patients, 18 years or older, from three selected inpatient units in the National Institutes of Health Clinical Center, participated.
  
  
  RESULTS
  A total of 331 patients were screened; 13 (4%) patients screened "positive" for suicide risk and received further evaluation. No patient had acute suicidal thoughts or required an observational monitor. Screening took approximately 2 minutes; 87% of patients reported feeling comfortable with screening; 81% of patients, 75% of nurses, and 100% of social workers agreed that all patients in hospitals should be screened for suicide risk.
  
  
  CONCLUSIONS
  Nurses can feasibly screen hospitalized medical/surgical patients for suicide risk with a two-item screening instrument. Patients, nurses, and social workers rated their experience of screening as positive and supported the idea of universal suicide screening in the hospital.
authors: Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. horowitzl@mail.nih.gov
authors: Lisa M
authors: LM
authors: Horowitz
authors: Deborah
authors: D
authors: Snyder
authors: Erica
authors: E
authors: Ludi
authors: Donald L
authors: DL
authors: Rosenstein
authors: Julie
authors: J
authors: Kohn-Godbout
authors: Laura
authors: L
authors: Lee
authors: Tannia
authors: T
authors: Cartledge
authors: Adrienne
authors: A
authors: Farrar
authors: Maryland
authors: M
authors: Pao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000451:nursing*; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods; D010343:Patient Admission; D061214:Patient Safety / Q000592:standards*; D017060:Patient Satisfaction; D010865:Pilot Projects; D058996:Quality Improvement; D012307:Risk Factors; D012947:Social Work; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult; D000092864:Suicide Prevention
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