Hospitals May Miss Opportunities to Identify More People With Suicide Risk

Suicide claimed more than 49,000 lives in the United States in 2022, the highest number ever recorded. Research shows that health care providers can play a key role in preventing suicide, given that almost half of those who die by suicide visit a health setting in the month before their death. However, a recent study shows that more than a third of U.S. hospitals are missing opportunities to identify more people experiencing suicidal thoughts or behaviors and connect them to care.

The Joint Commission, an independent national organization that accredits 70% of hospitals in the U.S., requires its nearly 3,800 facilities to screen and assess patients ages 12 and older for suicide risk only if they are seeking care for behavioral health conditions. Pew, in partnership with the Joint Commission, conducted a nationally representative study of accredited nonpsychiatric hospitals to quantify, for the first time, how many facilities exceed these standards and screen all patients—regardless of the reason for their visit—for suicide risk.

The survey, conducted in 2022, found that about 35% of respondent hospitals have not implemented comprehensive universal suicide screening—an evidence-based practice where all patients are asked whether they are experiencing suicidality using a validated screening tool; those that screen positive receive a comprehensive assessment to evaluate level of risk; and patients are provided referrals to follow-up care.

Of the hospitals not conducting universal screening, most cited multiple reasons for their decision, including an expectation of increased burden on providers, challenges incorporating screening into clinical workflows, and lack of accreditation requirements. However, when asked whether they were likely to implement universal screening in the future, most said they were extremely (32%) or somewhat (37%) likely to do so.

Universal screening is effective in identifying more people who may be experiencing suicidality than the current standard practice of screening only patients seeking care for behavioral health conditions. In fact, in one study comparing the two practices in emergency departments, health care providers identified twice as many patients experiencing suicide risk through universal screening than they would have if they did not screen everyone. Another study of emergency departments found that universal screening followed by evidence-based interventions reduced total suicide attempts by 30% for the year in which the study was conducted. According to the Pew-Joint Commission survey data, providers are aware of the patient safety benefits of this practice. Of the 65% of hospitals exceeding current screening requirements, most cited the importance of not missing patients who may be at risk for suicide as their primary reason for conducting universal screening.

Still, these hospitals reported implementation challenges, including insufficient staffing to provide safety interventions (51%), a lack of secure beds for patients who require hospitalization for immediate care (48.9%), and staff turnover (47%). Hospitals also reported successfully overcoming some of these challenges and cited a number of strategies and tools to do so, including:

• Training and recruiting dedicated staff and regularly assessing staff needs.
• Standardizing processes to promote efficient use of limited resources, such as integrating the screening tool and workflow related to screening, assessment, and care into electronic health record systems.
• Ensuring the commitment and support of hospital leadership.
• Identifying psychiatric safe spaces for patients, such as virtual or in-person support groups.
• Promoting multidisciplinary collaboration across specialties and professions at hospitals.
• Using telehealth, which gives patients greater flexibility to see a provider.

This study demonstrates that health care providers recognize the value of universal screening, but implementation challenges remain. More of these facilities may adopt the practice with strategies and tools to overcome those challenges, as well as guidance and support from experts in the field. Ensuring that patients experiencing suicide risk are connected to appropriate, immediate follow-up care is critically important. The study findings show that there is more work to do to improve care for patients with suicide risk and, ultimately, save lives.

The complete results and analysis of the screening survey were published January 26 in the Joint Commission Journal on Quality and Patient Safety.

Farzana Akkas works on The Pew Charitable Trusts’ suicide risk reduction project.