Emergency department safety assessment and follow-up evaluation 2: An implementation trial to improve suicide prevention

Contemp Clin Trials. 2020 Aug;95:106075. doi: 10.1016/j.cct.2020.106075. Epub 2020 Jun 19.


Background: Emergency departments (EDs) are important for preventing suicide. Historically, many patients with suicide risk are not detected during routine clinical care, and those who are often do not receive suicide-specific intervention. The original Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE 1) study examined the implementation of universal suicide risk screening and a multi-component ED-initiated suicide prevention intervention.

Purpose: The ED-SAFE 2 aims to study the impact of using a continuous quality improvement approach (CQI) to improve suicide related care, with a focus on improving universal suicide risk screening in adult ED patients and evaluating implementation of a new brief intervention called the Safety Planning Intervention (SPI) into routine clinical practice. CQI is a quality management process that uses data and collaboration to drive incremental, iterative improvements. The SPI is a personalized approach that focuses on early identification of warning signs and execution of systematic steps to manage suicidal thoughts. ED-SAFE 2 will provide data on the effectiveness of CQI procedures in improving suicide-related care processes, as well as the impact of these improvements on reducing suicide-related outcomes.

Methods: Using a stepped wedge design, eight EDs collected data cross three study phases: Baseline (retrospective), Implementation (12 months), and Maintenance (12 months). Lean methods, a specific approach to pursuing CQI which focuses on increasing value and eliminating waste, were used to evaluate and improve suicide-related care.

Conclusions: The results will build upon the success of the ED-SAFE 1 and will have a broad public health impact through promoting better suicide-related care processes and improved suicide prevention.

Keywords: Implementation science; Mental health; Quality improvement; Suicide; Suicide prevention.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Emergency Service, Hospital
  • Follow-Up Studies
  • Humans
  • Retrospective Studies
  • Suicidal Ideation
  • Suicide Prevention*