While an expert clinical interview is best practice in suicide risk assessment, in busy and complex clinical settings, such as emergency departments, even expert clinicians can miss important areas of inquiry due to reasons quite separate from their knowledge base and clinical skills (American Psychiatric Association, 2005). For example, in one recent study of at risk individuals discharged from an Emergency Department (ED), 55% had no documented assessment of access to lethal means despite having been assessed by experienced clinicians (Betz et al., 2016).
The consequences of under-identifying suicide risk can be catastrophic. Moreover, a comprehensive risk assessment and its documentation are critical to hospital practice and will be the key focus of scrutiny following a critical event.
The Osler Suicide Interview Checklist (OSIC) is a 25-item suicide risk assessment checklist designed for use by experienced clinicians in initial contact, such as in the ED, with a client who may be at risk of suicide. Following a risk assessment interview, and before determination of risk, the clinician pauses to complete the checklist as a way of verifying that critical areas of enquiry have been covered in the assessment.
Checklists are becoming more highly utilized in busy, complex and high risk settings where process errors, while infrequent, have potential for catastrophic consequence. The OSIC was developed as a clinician self-audit to be utilized following an expert interview to ensure comprehensiveness of assessment.
The OSIC is a true checklist analogous to pre-operative and pre-flight checklists in that it is brief and it is performed prior to the final determination of risk or safety (”The Checklist Manifesto”, Gawande, 2009). What is unique about the OSIC is that each checkmark answers the question, “Did I adequately assess this risk factor in my interview?” To our knowledge this is the first suicide self-audit instrument designed to be used in this manner. This reflects a process innovation in suicide risk assessment.
The OSIC has been well received by Psychiatrists and Crisis Workers in our busy emergency departments. Expert interviewers have informed us that it has helped them capture aspects of risk they would have missed had they not used the checklist. The OSIC has been adopted at other hospitals and a briefer version is being piloted for repeat assessments with our Mental Health inpatients.
The OSIC is time efficient, does not interfere with the clinical interview performed by experienced clinicians, and ensures that assessments cover all essential areas of inquiry.
Title:Chief of Psychiatry, Medical Director Mental Health and Addictions