The Columbia-Suicide Severity Rating Scale (C-SSRS) will be used to determine the patient’s suicide risk level during the ED rooming assessment.
The C-SSRS will be available in the following powerforms:
- Behavioral Health RN Assessment
- ED Rooming Assessment
- Admission Assessment – Inpatient
When filling out the C-SSRS:
- All seven questions must be answered for the score to generate
- Ask the questions exactly as written as this is how the tool is validated
- If the patient refuses to answer the questions, they must have 1:1 supervision until evaluated by a social worker. If this is the case, add refused to answer in the Comments for Social Work field.
- This tool is for all ED Behavioral Health and Eating Disorder patients. Do not use for inpatients.
- This is only for initial care. Once the Social Worker evaluation is complete, their recommendation will be followed if it differs from the scoring tool recommendation.
IView will be updated to include the new observation options. Type of observation in use should be included in the hourly RN assessment.
Effective May 3, 2022