Five-Year Implementation of Zero Suicide: Lessons Learnt From an Academic Health System.

Objective: The rising rates of suicide in the United States have motivated several interventions, including among health systems. A leading quality improvement approach for health systems is the Zero Suicide (ZS) model. Despite its well-recognized nature, implementation of ZS initiatives across health systems remains underutilized and understudied. We evaluated a 5 year-long real-world implementation of the ZS initiative in a behavioral health inpatient setting to understand strategies and challenges. Methods: Electronic medical record (EMR) data were used over a period of 5 years between January 2020, and June 2024, to study implementation of 3 clinician-delivered domains of the zero-suicide model, identify, engage, and transition. For each domain, we evaluated implementation rates and then stratified by demographic characteristics. We also estimated a logit model with individual-level data to examine whether implementation rates varied by demographic characteristic. Results: During the implementation period, 8810 individuals were hospitalized and included 5703 unique individuals. For each domain, attrition was noted. Racial and gender disparities were observed in all domains. While 100% of individuals were screened and stratified for risk level, approximately 80% of individuals identified as high risk received safety planning, and 53.3% accepted the proposed transition intervention. Refusal reasons ranged from having enough resources to feeling overwhelmed. Conclusion: Our study provides useful insights for behavioral health settings planning to implement the ZS initiative and discusses strategies including EMR integration. Relevance to Clinical Practice: For clinical systems incorporating ZS as a quality improvement implementation, this study provides suggestions about potential challenges, particularly related to sociodemographic disparities.