Using Electronic Health Record Alerts to Increase Safety Planning with Youth At-Risk for Suicide: A Non-randomized Trial

Background: No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide. Objective: This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community. Methods: An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation. Results: There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11). Conclusions: EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.