The Adoption and Implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) in a Psychiatric Emergency Service: Utilizing Roger's Diffusion of Innovations Model

Suicide is a major public health problem and the most dreaded patient outcome. Patient suicides are one of the top five most common sentinel events in health care. Within two months of discharge from an emergency department, one in ten patients will commit suicide. However, the exact number for completed patient suicides following an evaluation in a psychiatric emergency service is unknown. Patients present to the psychiatric emergency department in an acute crisis state often due to suicidal ideation and behaviors. Psychiatric emergency service clinicians are faced with performing a suicide risk assessment in a highly complex environment. Assessment practices vary across institutions and currently there is no universally accepted instrument. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a brief, valid, reliable instrument which makes its application well-suited for psychiatric emergency services. The objective of this quality improvement project is to evaluate the adoption and implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess suicidal ideation and behaviors of acute psychiatric patients, in a suburban, tertiary care, psychiatric emergency service using Roger’s Diffusion of Innovations model as a framework.  Results support a 90% uptake of the intervention for at least 6 months following the implementation.  Results from this project have the potential to improve comprehensive evaluations of suicide risk which augment clinical judgment  and may lead to an increase in effective interventions and decreased suicidal behaviors.