Abstract
Introduction
In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals.
Methods
The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries.
Results
There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services.
Conclusions
Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution.
Applicability of Research to Practice
This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.
Alcohol use and smoking in burn patients at the Helsinki Burn Center
