• Dana E M Seag, Paige E Cervantes, Iriane Narcisse, Ethan Wiener, Ee Tein Tay, Katrina Knapp, and Sarah McCue Horwitz.
• From the Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY.
• Pediatr Emerg Care. 2024 Oct 1; 40 (10): 731735731-735.

ObjectiveBecause understanding barriers to universal suicide risk screening in pediatric emergency departments (PEDs) may improve both identification and management of suicidal behaviors and ideation, this study assessed barriers to a quality improvement initiative examining the use of a novel computerized adaptive test (CAT), the Kiddie-CAT, in 2 PEDs.MethodsResearch assistants (RAs) trained in Rapid Assessment Procedures-Informed Clinical Ethnography methods documented barriers related to the environment, individuals, and workflow as encountered during screening shifts, categorizing the barriers' impacts as either general to a screening shift or related to screening an individual youth/caregiver dyad. Using thematic content analysis, investigators further categorized barriers based on type (eg, workflow, language/comprehension, clinician attitudes/behaviors) and relationship to the limited integration of this initiative into clinical protocols. Reasons for refusal and descriptive data on barriers are also reported.ResultsIndividual screen barriers were most often related to workflow (22.9%) and youth/caregiver language/comprehension challenges (28%). Similarly, workflow issues accounted for 48.2% of all general shift barriers. However, many of these barriers were related to the limited integration of the initiative, as RAs rather than clinical staff conducted the screening.ConclusionsAlthough this study was limited by a lack of complete integration into clinical protocols and was complicated by the COVID-19 pandemic impacts on PEDs, the findings suggest that considerable attention needs to be directed both to physician education and to workflow issues that could impede universal screening efforts.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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