Ask Suicide-Screening Questions to Everyone in Medical Settings: The asQ'em Quality Improvement Project

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 2-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: 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. DISCUSSION: Nurses can feasibly screen hospitalized medical/surgical patients for suicide risk with a 2-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