Suicide Risk Response: Enhancing Patient Safety Through Development of Effective Institutional Policies

A suicidal patient requires a prompt, coordinated intervention. In this paper, we describe a process for developing a suicidality policy, which may help clinics develop effective, locally adapted policies. We present the process in the framework of the Quality Improvement Plan-Do-Study-Act cycle. The process we describe occurred as part of a quality improvement project. Translating Initiatives for Depression into Effective Solutions (TIDES) is an evidence-based, quality improvement intervention for depression, implemented in seven Veterans Administration primary care clinics in five states. A multidisciplinary workgroup, the Collaboration Workgroup (CWG), created for this project supports the collaborative care process through evaluation and improvement of policies, including those for institutional response to suicidality. During the “plan” phase, the workgroup reviewed existing policies from each of the seven participating intervention clinics. This review revealed significant gaps and implementation difficulties. During the “do” phase, workgroup members developed or adapted site-specific policies as needed based on the initial CWG review, and assisted sites in implementing them. During the “study” phase, workgroup members reviewed what had worked and what had not worked in implementing policies for threatened suicide at each site, and identified a set of key features of successful policies. Features included a clearly defined chain of responsibility, well-defined followup procedures, and documentation of actions in the medical record. The workgroup developed templates that emphasized these key features but allowed for necessary local adaptation. Workgroup clinicians assisted clinics to implement site-specific policies. During the “act” phase, which is ongoing, site policies are in effect and are being evaluated.