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

Edwin D Boudreaux; Brianna L Haskins; Celine Larkin; Lori Pelletier; Sharon A Johnson; Barbara Stanley; Gregory Brown; Kristin Mattocks; Yunsheng Ma

doi:10.1016/j.cct.2020.106075

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.

Authors

Edwin D Boudreaux¹, Brianna L Haskins², Celine Larkin³, Lori Pelletier⁴, Sharon A Johnson⁵, Barbara Stanley⁶, Gregory Brown⁷, Kristin Mattocks⁸, Yunsheng Ma⁹

Affiliations

¹ Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: Edwin.boudreaux@umassmed.edu.
² Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: Brianna.haskins@umassmed.edu.
³ Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: Celine.larkin@umassmed.edu.
⁴ Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, USA. Electronic address: lpelletier01@connecticutchildrens.org.
⁵ Foisie Business School, Worcester Polytechnic Institute, Worcester, MA, USA. Electronic address: sharon@WPI.EDU.
⁶ Department of Psychiatry, Columbia University, New York, NY, USA. Electronic address: bhs2@cumc.columbia.edu.
⁷ Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: gregbrow@pennmedicine.upenn.edu.
⁸ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: Kristin.mattocks@umassmed.edu.
⁹ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: yunsheng.ma@umassmed.edu.

Abstract

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*

Grants and funding

R01 MH106726/MH/NIMH NIH HHS/United States