Northwestern Medical Center (NMC) recently joined all 14 Vermont hospitals in implementing a new screening procedure to better identify patients who may be at risk of suicide. The Vermont Suicide Prevention Center identifies Vermont as having the highest rate of suicide in New England, with Franklin County having the highest prevalence in the state of Vermont. National statistics further show that 44% of people who die by suicide have had an Emergency Department visit in the preceding 90 days. 
 
To help address this critical issue, Northwestern Medical Center collaborated with Northwestern Counseling & Support Services (NCSS) and the Vermont Program for Quality in Health Care (VPQHC), to implement new evidence-based screening procedures to improve how NMC’s Emergency Department identifies patients at risk for suicide. 
 
Rachael Shepardson-Rudden, Nurse Manager of NMC’s Emergency Department, said the new screening process has the potential to open a whole other side of the story  when a patient presents to the Emergency Department for seemingly unrelated ailments. NMC and NCSS worked for two years to develop and implement new protocols, documentation and best practices. Prior to this program, NMC’s screening for suicide was often limited to patients who presented to the Emergency Department in mental health crisis.  
 
Under the new approach, all patients over the age of 12 are asked standardized questions, designed by the National Institute of Mental Health, to bring potential suicide concerns to the surface. During a recent triage session, Emergency Department nurse Heather Tremblay asked the new standardized questions of a patient who was having suicidal thoughts, but those thoughts were not the reason for the Emergency visit. Heather said the patient seemed appreciative. “It took him off guard, and a look of relief crossed his face”, she said. NMC also screens pediatric patients from the ages of 8 to 11 years old but only if they present with a mental health complaint, as is best practice.  
 
While most patients may not be at risk of suicide, the new screening process helps identify those who are at risk, allowing care teams to implement appropriate interventions and treatment. These treatment plans may include referrals to NCSS, an integral partner in setting up this new program. “NMC and NCSS have worked well together, and this Universal Suicide screening practice will provide additional benefits for the patients”, said Kevin King, RN. King said his work as a nurse in NMC’s ED for over 30 years led him to focus on patients’ mental health needs and in 2022 he completed his MSW and is now working as a crisis clinician for NCSS.  
 
“I feel that screening patients for their mental health needs and having a collaborative approach with the community mental health agency makes for better outcomes and is best practice,” said King.  
 
Tony Stevens, the Emergency Services Program Manager for NCSS agreed. “I have worked on the NCSS Crisis Team (Emergency Services Team) and managed it for the past 23 years,” he said. “Over the years, the idea of universal suicide screenings in the ED or at Triage have been discussed but there have been barriers to implementation.” Stevens said that the collaborative roll-out of the new process has allowed both NMC and NCSS to do so in an achievable way for both organizations. 
 
In the eight weeks following the start of the program, 251 patients were identified as having concerns around suicide or suicidal ideation and 53 were actively considering suicide. Eleven patients that presented with a medical chief complaint also disclosed that they were having suicidal thoughts while in the Emergency Department. Without the new procedures, these eleven patients may have not gotten the resources or treatment for their suicide concerns.     
 
The early numbers have been eye opening at NMC.  
 
“I’m very proud of the work our team has done to ensure the safety and wellbeing of our patients,” said NMC President and CEO Peter J. Wright, FACHE. “It has already made a noticeable and measurable difference. This is one more step in our journey to become a highly reliable organization.” 
 
If you are having thoughts of suicide or have concerns about someone who may be considering suicide, please seek help by calling Northwest Counseling Support Services at 1-802-524-6554, option #1 for Crisis, or, call or text the National Suicide Prevention Hotline at 988. 
 
Visit the Vermont Program for Quality in Health Care (VPQHC) at https://www.vpqhc.org/ for more information  about the Vermont Emergency Department Suicide Prevention Quality Improvement Initiative. 
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