Honors Theses and Capstones

Date of Award

Spring 2023

Project Type

Senior Honors Thesis

College or School




Program or Major


Degree Name

Bachelor of Science

First Advisor

Kerry Nolte

Second Advisor

Sara Robinson

Third Advisor

Kimberly Force


Background: Implementation of a universal suicidality screening is considered best practice as it is associated with improved the detection of occult, or latent, suicide risk and can reduce subsequent risk. This quality improvement (QI) project evaluates the implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) to screen patients over the age of twelve at a regional healthcare system.

Methods: The QI project was conducted at Littleton Regional Healthcare (LRH) emergency department, a critical-access hospital in Littleton, New Hampshire that serves about 206 patients per week. Implementation of suicidality screening was of interest to LRH to promote mental health in the communities they support. The QI project utilized three plan-do-study-act (PDSA) cycles. PDSA cycle one involved monitoring the current use of suicidality screening from January 2023 – February 2023. PDSA cycle two was the implementation of the screening protocol from February 2023 – March 2023. PDSA cycle three was providing staff education from March 2023 – March 2023.

Results: In PDSA cycle one, 11% of patients (n=66) were screened out of 585 total. In cycle two, 17% of patients (n=111) patients were screened out of 656 total patients. In cycle three, 28% (n=170) patients were screened out of 613 total patients.

Conclusion: The PDSA cycles resulted in an increase in universal suicidality screening from 11% to 28% (t=4.143, p<.001). This demonstrates an increase in the rate of screening; however, further work needs to be done to determine further barriers to implementing universal screening in the emergency department at a higher rate of success. Short-term impacts include early risk identification and early intervention for patients who might not have been identified as an at-risk person and long-term impacts can include improved detection of occult suicide risk, reduced subsequent risk, streamlined interventions, and decreased cost to the hospital.