Improving Care for Youth Admitted to Medical Units Following Attempted Suicide

Objective: Despite high rates of youth suicide, it is uncommon for children and adolescents admitted to inpatient medical units following attempted suicide to receive psychotherapeutic treatment in that setting. Our hospital saw increasing numbers of patients admitted for medical stabilization following attempted suicide, as well as longer wait times to transfer for psychiatric care, and almost none were discharged to care in less restrictive treatment settings. This quality improvement project aimed to increase access to psychological care during medical admissions. Methods: We designed a new model of care to provide enhanced psychotherapeutic intervention to patients awaiting medical stabilization with aims to increase treatment time and decrease inpatient psychiatric admissions and overall lengths of stay across medical and psychiatric hospitalizations. A psychologist met with youth who opted to engage in treatment work to explore contributing factors to their suicidal event, set goals for treatment, and develop coping strategies. Behavioral health specialists, who provide one-to-one safety observation, participated in training to support the practice of coping skills with patients at bedside. We collected retrospective data from 2 years prior and 1 year of pilot data while the new model of care was implemented. Results: Despite several unforeseen challenges with implementation, the model appeared acceptable to most youth to whom it was offered, and several were able to stabilize and discharge to less restrictive treatment once medically stable. Conclusions: Our model of care showed promise as an intervention for early psychiatric stabilization on medical units following attempted suicide. Implications for Impact Statement Providing psychotherapy to youth admitted to medical hospitals following attempted suicide is well-accepted among youth and holds potential to serve as a model of rapid stabilization toward discharge to outpatient care.