Effective Administration of Mental Health Screening Tools Affects Appropriate Allocation of Resources and Improves Clinician Ability to Identify Those at Risk for Suicide

Background: Suicide is now the second leading cause of death among children and young people ages 10-24 years of age with the CDC 2017 National Youth Risk Behavior Survey reporting 7% of high school students reported attempting suicide, making it a serious public health problem in our youth. The goal of this QI initiative was to reduce the number of false positive answers reported by patients on the PHQ-9 suicide specific question in an outpatient pediatric sports medicine clinic, thus to better assure proper resource allocation to true positive responses. The PHQ-9 is a validated depression screening questionnaire commonly used in the pediatric setting. Methodology: A high number of false positives were reported in 2017 after the PSQ-9 was implemented to screen patients ≥12 years of age for depressive symptoms. In Spring 2018, the team, (psychology and clinical staff and an EPIC EMR specialist) developed a new approach in an attempt to decrease the high number of false positives being reported. The PHQ-2 was implemented as a pre-screener, and those with scores concerning for depression, then received the full PHQ-9 questionnaire. Mid-2018 a summary page was created to allow the patient to review their answers prior to final submission. This further eliminated false positives by reducing patient entry errors that were commonly reported. All patients from April 12, 2017- December 31, 2019 who endorsed thoughts of feeling better off dead or wanting to hurt themselves triggered a BPA (Best Practice Alert) through the EMR system, alerting the clinical team for further assessment and were included in our evaluation. A chart review was conducted by the treating physicians to ascertain if the BPA triggers of their patients were true positive or false positives. Discussion: 78 patients with a mean age of 14.29 (±2.05) triggered a total 83 BPAs. Of those 83, 36 were false positives. Of the true positives, 38 (81%) were female and 9 (19%) were male. Among the 42 true positives, the most common reasons for visit were concussion (26%) and back pain (21%). The number of false positive BPAs decreased each year from 2017 through 2019 (Figure 1). Implementation of the layered screening tool and the ability to review for mistakes led to fewer false positives and resulted in a more efficient allocation of resource. Conclusions: Our data showed that the changes implemented successfully reduced the number of false positives and concentrated the allocation of resources for at risk individuals. In March 2020, we switched from the PHQ-9 to the ASQ (Ask Suicide Questions). The next step is to see if implementation of the ASQ further reduces the percentage of false positives seen in an outpatient pediatric sub-specialty clinic and improves capturing those at risk for suicide.