Since 1999, rates of suicide have increased in nearly every state in the United States. In 2016 alone, nearly 45,000 lives were lost to suicide.

This is a trend that has not spared the Commonwealth of Kentucky: suicide is the eleventh leading cause of death in the state.

At UK HealthCare, providers have noticed this alarming trend. For the past six months, they have been working together with administrators to develop a plan to integrate the use of an evidence-based screening tool aimed at identifying those at risk of dying by suicide and connecting them with care and support services.

On May 28, 2019, the UK Emergency Department began utilizing the Columbia-Suicide Severity Rating Scale at both UK HealthCare Albert B. Chandler and Good Samaritan Hospitals. This screening tool is used to collect information on an individual's risk factors. 

“Patients will be asked brief questions using age-appropriate versions of the screening tool to determine if additional screening is warranted," said Dr. Abner Rayapati, assistant professor in the UK Department of Psychiatry. 

While screening has often been done in various clinical settings at UK, this new initiative better integrates and standardizes the screening that is being done across specialties. Marc Woods, assistant chief nurse executive in the UK College of Medicine Department of Behavioral Health, said this new approach ensures a consistent approach to screening.

“We all speak a common language, because we’re all using the same tool within a system of care,” Woods said. 

The screenings will take place in several primary care and high-risk specialist clinics, as well as those who are admitted to the hospital at UK. Everyone over the age of 12 will be screened under the new protocol, and children between five and 12 years of age will be screened if they present to the emergency room with a mental health concern.

After completing the assessment, practitioners will determine if an individual is low, moderate or high risk for suicidal ideation. From there, they will be referred to follow-up care with a private physician in UK’s Department of Psychiatry, at University Health Service or wherever seems most appropriate for that individual. Patients will also receive a phone call from the department that referred them to see if they were able to connect to care and provide additional assistance if needed.

“This type of screening is something providers feel must be provided in order to fill our mission as the University FOR Kentucky,” Woods said. “We have a responsibility as a high-access hospital to provide appropriate screenings in order to provide the best patient care for patients with behavioral health needs.”

Over the past six months to a year, providers have received training and communication tailored to their role in the healthcare process – what a nurse does, for example, is different than the role of a physician’s assistant. They are also learning ways to change the environment to reduce the risk of self-harm or injury for patients who remain inpatient for treatment.

Data are being collected along the way to help determine whether the intended goals of the new protocol are being met and to continue to better integrate and streamline the process. Efficiency and effectiveness are important measures for the program.

While these changes add a few extra steps to the work done by providers, and a few more minutes to appointment times, they are well worth it, Woods says.

“We’ve identified people who we may not have previously identified," he said. "It’s worth the additional time and work.”

These changes are part of UK HealthCare’s goal of better integrating behavioral health and general healthcare, according to Sarah Lester, UK director of nursing professional practice and excellence.

“This aligns with our goal to treat the whole patient,” Lester said. “It’s providing stability to our patients in a time of crisis.”