Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Michael Terry, DNP, FNP, PMHNP

Second Advisor

Jim Kane, MN, RN, CNS, CEA-BC

Third Advisor

Cresilda Newsom, DNP, MSN, RN, CPAN


TITLE: Screening for suicide risk in the outpatient electroconvulsive therapy population

BACKGROUND: Reducing risk for suicide continues to be a national hospital patient safety goal. Suicide is the 10th leading cause of death in the United States and suicide rates have increased 33% in the last decade. It has been found that 83% of those who die by suicide received healthcare services in their last year of life, thus healthcare providers are uniquely suited to play a role in identifying suicidality. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a validated tool developed by Columbia University, University of Pennsylvania, and the University of Pittsburgh and is supported by the National Institute of Mental Health. The C-SSRS has been found to have high sensitivity and specificity in quantifying the severity of suicidal ideation and behavior. Electroconvulsive therapy (ECT) patients are particularly vulnerable due to the likelihood of major affective or psychotic disorders that are resistant to other treatments as ECT is not a first-line treatment. Screening in conjunction with routine ECT treatment can identify individuals with current risk for acting on suicidal behavior and impulses.

PURPOSE: Implementation of suicide screening using a validated tool, the C-SSRS, in the pre-procedural intake process for all ECT outpatients. Current UCSDH practice does not include the use of a validated tool in screening for suicide in this population. Additionally, screening individuals during the course of ECT treatment has not been rigorously studied and demonstrating the incidence of suicidality in this population is valuable.

FRAMEWORK: The Iowa Model of evidence-based practice to promote quality care was used in the development of this project to implement change in the perianesthesia department at the Hillcrest medical campus of the University of San Diego Health (UCSDH).

EVIDENCE-BASED INTERVENTIONS: This project consisted of implementation of the C-SSRS for suicide screening in the outpatient ECT population.

EVALUATION OF RESULTS: During a 4-week period, the C-SSRS was administered 60 times to 25 different ECT outpatients at the UCSDH Hillcrest. The patients were screened using the C-SSRS and based on their responses, were stratified into risk categories and the corresponding interventions were implemented. After 2 weeks of implementation, two ECT outpatients were found to be high risk for suicide. Upon assessment by the psychiatrists performing the ECT, the patients were determined to be safe to discharge home.