Open Forum

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Lorraine

Thank you for your response. So, in your clinics, you guys are putting patients on 5150? How impactful is that from an operation standpoint as hold patients would take up a staff and exam room? Or are they being putting on a 5150 by the practitioners and send via 911 to the ER?

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Lorraine

Thank you for your response. So, in your clinics, you guys are putting patients on 5150? How impactful is that from an operation standpoint as hold patients would take up a staff and exam room? Or are they being putting on a 5150 by the practitioners and send via 911 to the ER?

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Jamie

Do you by any chance happen to have a policy that you are willing to share?

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Kristy,

We use the CSSRS for Adults and ASQ (Ask Suicide-Screning Questions) for pediatric patients in our Ambulatory clinic sites. The NIH provides amazing resources, including screening tools and clinical pathways: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials. They have different pathways depending on the setting (ED vs Inpatient vs Ambulatory). 

Hope this helps.

Marissa Herrera, DNP, RN

MSU Health Care

herrer74@msu.edu

Hi Jamie

Do you by any chance happen to have a policy that you are willing to share?

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Thank you for providing that resource. Appreciate it. 

Hi Kristy,

We use the CSSRS for Adults and ASQ (Ask Suicide-Screning Questions) for pediatric patients in our Ambulatory clinic sites. The NIH provides amazing resources, including screening tools and clinical pathways: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials. They have different pathways depending on the setting (ED vs Inpatient vs Ambulatory). 

Hope this helps.

Marissa Herrera, DNP, RN

MSU Health Care

herrer74@msu.edu

Hi Jamie

Do you by any chance happen to have a policy that you are willing to share?

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Kristyl,

If you send me your email I'd be happy to share with you what we have developed. We are also in California.

Thank you for providing that resource. Appreciate it. 

Hi Kristy,

We use the CSSRS for Adults and ASQ (Ask Suicide-Screning Questions) for pediatric patients in our Ambulatory clinic sites. The NIH provides amazing resources, including screening tools and clinical pathways: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials. They have different pathways depending on the setting (ED vs Inpatient vs Ambulatory). 

Hope this helps.

Marissa Herrera, DNP, RN

MSU Health Care

herrer74@msu.edu

Hi Jamie

Do you by any chance happen to have a policy that you are willing to share?

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Kristyl,

If you send me your email I'd be happy to share with you what we have developed. We are also in California.

Thank you for providing that resource. Appreciate it. 

Hi Kristy,

We use the CSSRS for Adults and ASQ (Ask Suicide-Screning Questions) for pediatric patients in our Ambulatory clinic sites. The NIH provides amazing resources, including screening tools and clinical pathways: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials. They have different pathways depending on the setting (ED vs Inpatient vs Ambulatory). 

Hope this helps.

Marissa Herrera, DNP, RN

MSU Health Care

herrer74@msu.edu

Hi Jamie

Do you by any chance happen to have a policy that you are willing to share?

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

------------------------------
Jamie White
Director, Primary Care Clinics
Boys Town National Research Hosp
Omaha NE
(531)355-6993

Original Message:
Sent: 11-17-2023 16:45
From: Kristyl McCray
Subject: Management of Pts expressing suicide in a ambulatory care setting

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

------------------------------
Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

This is in line with our process as well. In Georgia we have a '1013' which allows a physician to emergently transport a patient via EMS in the case of acute suicide risk. However, we rarely have to use this option as parents typically consent to transfer. We are a pediatric facility and screen using the ASQ. If a patient answers yes to having suicidal thoughts and a plan the positive screen triggers additional action which includes placing them on 1:1 observation and calling 911. In some instances, if the patient is currently undergoing treatment or the parent objects to transportation to the emergency room, we also have a state phone line - GCAL - Georgia Crisis and Access Line that can provide immediate resources as well. We do not have social work in many of our practices, but we do have on call SW resources that can be reached via phone to assist.  

------------------------------
Brandy Williamson MSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Brookhaven GA
(404)785-8978
brandy.williamson@choa.org

Original Message:
Sent: 11-20-2023 09:36
From: Jamie White
Subject: Management of Pts expressing suicide in a ambulatory care setting

Good morning, 

Currently in our clinics, we put the patient on 1:1 monitoring and call 911.  Generally we try to request EMS instead of police to transfer the patient to the nearest ER.

Jamie 

------------------------------
Jamie White
Director, Primary Care Clinics
Boys Town National Research Hosp
Omaha NE
(531)355-6993

Original Message:
Sent: 11-17-2023 16:45
From: Kristyl McCray
Subject: Management of Pts expressing suicide in a ambulatory care setting

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

------------------------------
Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

We have a protocol for "patient in the clinic" and another for "patient on the telepone. I have attached them both. 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

We have a protocol for "patient in the clinic" and another for "patient on the telepone. I have attached them both. 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Patricia

Thank you for taking the time out to share those documents. I did review them, and I do have a follow up question. Do these protocols apply to all ambulatory care setting (primary care and specialty care)? And does the staff ever call for additional evaluations while the patient is still in the clinic, such as a PET team or other types of crisis response team?

I guess that was 3 questions :) 

We have a protocol for "patient in the clinic" and another for "patient on the telepone. I have attached them both. 

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Kristyl,

Here in Dallas we have a suicide policy for our ambulatory staff that has an attached appendix with algorithms to follow that include how to handle a suicidal patient either in person or over the telephone. The policy includes contacting social work (if there is one in that clinic, not all of our clinics have one), campus police, contacting 911, and referral to our emergency psych service to determine if appropriate for direct admission. The patient must remain on a 1:1 until evaluation. I am a telephone triage educator and I also provide this education to all staff at onboarding on how to handle these patients over the telephone as well.

Thank you,

------------------------------
Alicia Bosse BSN, RN, CMS-RN
Clinical Nurse Educator
UT Southwestern
North Tower
8200 Brookriver Drive
Dallas, Texas 75247

UT Southwestern
Medical Center
------------------------------

Original Message:
Sent: 11-17-2023 16:45
From: Kristyl McCray
Subject: Management of Pts expressing suicide in a ambulatory care setting

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

------------------------------
Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Hi Kristyl,

Here in Dallas we have a suicide policy for our ambulatory staff that has an attached appendix with algorithms to follow that include how to handle a suicidal patient either in person or over the telephone. The policy includes contacting social work (if there is one in that clinic, not all of our clinics have one), campus police, contacting 911, and referral to our emergency psych service to determine if appropriate for direct admission. The patient must remain on a 1:1 until evaluation. I am a telephone triage educator and I also provide this education to all staff at onboarding on how to handle these patients over the telephone as well.

Thank you,

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi Kristyl,

Here in Dallas we have a suicide policy for our ambulatory staff that has an attached appendix with algorithms to follow that include how to handle a suicidal patient either in person or over the telephone. The policy includes contacting social work (if there is one in that clinic, not all of our clinics have one), campus police, contacting 911, and referral to our emergency psych service to determine if appropriate for direct admission. The patient must remain on a 1:1 until evaluation. I am a telephone triage educator and I also provide this education to all staff at onboarding on how to handle these patients over the telephone as well.

Thank you,

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.  

Hi, 

Coming a little late to the conversation.

In NYS, as mentioned in a prior response, patients can be considered to lack capacity if they express suicidal ideation and can be sent to an ER.

We instruct staff that any call or live patient in the ambulatory practice who makes any reference to suicide or 'killing themselves,' is immediately referred to a health care provider or RN. We teach RNs during orientation and triage classes to evaluate for suicidal ideation and plan. Either alone, or in conjunction with medical provider, they immediately call an ambulance, letting them know the patient is expressing suicidal ideation and any specific mention of method, and identify themselves as a mandated reporter / licensed health care professional. If live visit in the practice site, the patient is not left alone until ambulance arrives. If the communication is via telephone, patient is kept on phone, try to identify if someone else is with them, and the RN calls the ambulance or similar service (safety check) to take the patient to ER.  If it is a message, RN attempts to call patient, and any emergency contacts, however if cannot make contact, sends a safety check ambulance to the most likely address.

We also share with practices for appropriate patients:   

[Original #:  1-800-273-TALK (8255) is still in operation]

•Substance Abuse and Mental Health Services Administration (SAMHSA) agency of: Dept of HHS

We do not have a policy specifically stating this, but would be interested if anyone else has verbiage and/or policy to share.

Regards,

Hello

I am looking to see how other clinics handle individuals experiencing suicidal intentions. Not screening but actually how these individuals are being handled when they present in your clinic expressing wanting to harm themselves with or without a plan. Do you have social workers to assist? Do you transport to the ER via EMS or 911? Do you call the psychiatric mobile response team or PET team, and hold them in your clinic? How do you handle this population?

Any information, protocols, and policies would be greatly appreciated.