Interruptive clinical decision supports may be more sensitive for suicide screening

1. In this randomized clinical trial (RCT) comparing two forms of clinical decision support (CDS) prevention, interruptive CDS prompted more in-person assessments compared to noninterruptive CDS for suicide screening. 

Evidence Rating Level: 1 (Excellent) 

Effective suicide prevention includes accurately identifying individual risk, predicting outcomes, and appropriate intervention. One possibly helpful but under-researched area that has yet to be evaluated in a randomized clinical trial (RCT) is the use of clinical decision support (CDS) in suicide prevention. Previous data has shown that screening during healthcare encounters is of utmost importance as many individuals who die by suicide had recent contact with primary care. Due to gaps in screening methods, several models have been created with recent research suggesting that statistical modelling and face-to-face screening combined is more effective than either alone. The objective of this study was to determine if interruptive CDS lead to more frequent in-person suicide risk assessments than noninteractive CDS and determining if CDS in general increased in-person screening rates. To address this goal, a 2-arm RCT was employed with patients randomly assigned in a 1:1 ratio if their predicted risk was 2% or greater. Patients were eligible for randomization if they were routinely seen in primary care settings. For the design, the interruptive CDS had an alert window and a patient icon that were simultaneously visible while the non-interruptive CDS had a summary panel. A total of 596 of 7732 encounters and 561 of 6062 patients were enrolled and randomized (mean [SD] age, 59.3 [16.5] years). The interruptive CDS arm included 289 encounters, of which, clinicians chose to screen in 121 (42%) cases, with an assessment of their choosing. In the noninterruptive CDS arm, there were 307 encounters, of which the clinicians chose to screen in 12 (4%) cases. These results show that there were higher rates of in-person screening in the interruptive CDS compared to the noninterruptive CDS (odds ratio, 17.70; 95% CI, 6.42-48.79; P<.001). Once again compared to the noninterruptive arm, the interruptive CDS was associated with a higher overall frequency of documented suicide risk assessments. (11 of 307 encounters [4%] compared with 63 of 289 encounters [22%]; P<.001). In the same clinical settings, the suicide risk assessment rate was 8% in the prior year at baseline (64 of 832 encounters), compared to the current study rate of 22% (63 of 289 encounters). The results of this RCT demonstrate that interruptive CDS was more effective than noninterruptive CDS in prompting in-person assessments. 

Click to read the study in JAMA Network Open

Image: PD

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