Organization Profile
Ann & Robert H. Lurie Children’s Hospital of Chicago is one of the premier children’s hospitals in the country and the only freestanding hospital in Illinois exclusively for children. Lurie Children’s is the pediatric training and teaching hospital of Northwestern University Feinberg School of Medicine. Lurie Children’s medical staff includes more than 1,800 physicians and allied health professionals who offer expertise in 70 pediatric specialty areas. Lurie Children’s has an inpatient capacity of 360 beds and treats children from around the world. The hospital operates 17 outpatient centers, six primary care locations, and 10 partner hospitals throughout Chicago and its suburbs, providing greater access to pediatric care for all children. In fiscal year 2023, Lurie Children’s treated approximately 250,000 children.
Zero Suicide Implementation Summary
In 2020, Lurie Children’s Teamwork to Reduce Infant Child and Adolescent Mortality (TRICAM) program focused on addressing pediatric mortality from the leading causes of death. Youth suicide became an initial area of focus due to increasing rates, especially among younger children. To aid TRICAM's suicide prevention efforts, TRICAM and colleagues from the Pritzker Department of Psychiatry and Behavioral Health applied for and were awarded competitive grant funding from the Cardinal Health Foundation to participate in the inaugural Cardinal Health Foundation Zero Suicide Collaborative. Through this participation in the Collaborative, Lurie Children’s began the guided process of Zero Suicide implementation. The organization worked diligently to build an interdisciplinary team of leaders and champions, facilitate cross-communication between departments and teams, evaluate organizational and workforce needs related to suicide risk assessment and prevention, synergize ongoing activities, prioritize institutional needs, build supporting infrastructure, and secure programmatic funding. Over the past four years, the team has achieved five notable accomplishments, which are described briefly below. Through this work, Lurie Children’s has strengthened its institutional commitment to addressing youth suicide.
Key Outcomes
Success 1: Branding Our Team
The Zero Suicide core team evolved in size and structure and was formally branded in 2022 as the Lurie Children’s Suicide Prevention and Research Collaborative (L-SPARC) after receiving generous philanthropic support from Schreiber Philanthropy and Beth and Steven Pagnotta to help sustain and grow the program. Today, the L-SPARC core multidisciplinary team includes adolescent and young adult medicine physicians, child and adolescent psychiatrists, child psychologists, pediatric emergency medicine physicians, psychiatric social workers, clinical informaticians, operations specialists, and researchers. The work is structured in five cross-cutting domains: Clinical Care; Community Engagement; Operations; Provider Training; and Research. Each domain has a principal lead, but all members work across the domains.
Success 2: Development of EPIC Suicide Prevention Toolkit and Power BI Dashboards
L-SPARC collaborated with operational teams across the institution to create a custom-built suicide prevention toolkit in the EPIC system. This large-scale effort involved diverse groups such as Information Management, the Center for Quality and Safety, Data Analytics and Reporting, Nursing Informatics, Legal, Risk Management, Revenue Cycle, Education and Training, and others. The toolkit provides an integrated location in EPIC to access evidence-based tools that facilitate standardized procedures and documentation, improving the quality of care. The toolkit was designed for use across the continuum of patient care to identify suicide risk, assess the level of risk, aid in safety planning, and provide clinicians with helpful resources. A second, similarly complex project complemented the EPIC toolkit build: many of the same groups worked together to identify key outcome and process measures and create a series of dashboards in Power BI to monitor and evaluate these measures in EPIC data for specific clinical settings and the entire organization.
Success 3: Development of Clinical Care Guidelines/Workflows
Lurie Children’s institutional administrative policy requires universal suicide screening of all patients 10 years and older, as well as all patients presenting for psychiatric concerns. To improve compliance with this policy and the quality of patient care, it became necessary to standardize suicide workflows and processes within clinical areas and across the organization. This work included mapping workflows by division, identifying appropriate roles (e.g., physician, nurse, social worker) to conduct each step of the process, developing a matrix of required actions for each level of risk for patients with a positive suicide screen, and identifying appropriate escalation responses for positive screens. The Nursing Quality Council and the Center for Quality and Safety, in partnership with the L-SPARC team, largely conducted this successful, coordinated, multidisciplinary effort.
Success 4: L-SPARC Intervention Clinic
In 2023, L-SPARC created the L-SPARC Intervention Clinic to meet the immediate needs of youth 10-17 years old who express suicidal thoughts and behaviors. The clinic is intended for those who do not require inpatient psychiatric care but may benefit from outpatient assessment and short-term therapy to stabilize suicidal thoughts and behaviors. Youth are referred to the clinic from the Emergency Department or the Psychiatry Consult Service and receive 6-8 outpatient sessions of behavioral therapy. The clinic also aims to improve mental health and suicide prevention expertise in the future workforce by serving as a training clinic for clinical psychology and social work graduate students. Students are taught suicide-specific interviewing and assessment skills, case conceptualization, treatment planning, and therapy skills. All trainees receive live clinical supervision for every session.
Success 5: Leaders in Suicide Prevention Research
Members of the L-SPARC team are leading or serving as co-investigators in a growing portfolio of youth suicide-related research. The investigators have been awarded competitive research support from federal agencies such as NIMH, HRSA, and SAMHSA, as well as non-federal sources such as the American Foundation for Suicide Prevention and the American Psychological Association. Some of the latest research in progress is possible due to the institutional infrastructure built by Lurie Children’s (e.g., EPIC toolkit, dashboards, Clinical Care Guidelines) and the resulting standardized data. The team is engaged in suicide prevention research related to racial disparities, vulnerable and high-risk populations, risk factors, firearms and lethal means safety, and suicide-focused treatment.
Key Outcomes Summary
- A 5-year programmatic plan and a recognized team of experts now lead and synergize suicide prevention activities across the organization, championing improvement opportunities.
- Standardized workflows and documentation processes allow the collection of high-quality data, facilitating the evaluation of process and outcome metrics.
- Suicide screening compliance for the Emergency Department and Inpatient settings increased from 25% when the institutional policy for universal suicide screening of children 10 years and older was implemented three years ago to 86% today.
- In its inaugural 9 months, the L-SPARC Intervention Clinic has provided immediate short-term therapy for 19 youth and has offered in-depth training in suicide prevention and therapeutic skills for 9 future clinicians.
- L-SPARC researchers have published 14 suicide prevention-related publications in peer-reviewed journals, contributing to the growing body of knowledge regarding youth suicide.
Next Steps
- Continue making iterative improvements to the technology infrastructure (EPIC suicide prevention toolkit and Power BI and data dashboards).
- Train more members of the workforce on how to assess the level of suicide risk and the associated required actions to improve mental health capacity and competency among non-mental health specialty providers.
- Scale up the L-SPARC Intervention Clinic to offer one more clinic day each week, equating to 16 more clinic sessions per month.
- Develop a strategic plan to grow the research mission.
- Obtain funding to ensure programmatic longevity and growth.