Emergency Providers Intervene to Prevent Suicide Attempts, Ideation

By Jonathan Springston, Editor, Relias Media

Using continuous quality improvement (CQI) techniques to enhance workflows, healthcare workers at eight U.S. emergency departments (EDs) reduced the likelihood of suicide, suicidal ideation, and suicide-related behaviors in the 12 months after a patient’s first ED visit.

In the Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial, a stepped-wedge, cluster, randomized clinical study, investigators sought to improve how healthcare providers treat possibly suicidal patients. Researchers divided their work into three 12-month sequential phases: baseline, implementation, and maintenance. The authors used the Patient Safety Screener (PSS) to determine which patients age 18 years and older were at risk. Twenty-five patients were selected randomly per month, with data collected from January 2014 to April 2018. Investigators focused first on patients who were discharged from the ED, then all patients who screened positive on the PSS, regardless of disposition.

At the participating EDs, emergency providers evaluated suicide-related workflows, identified improvement opportunities, and worked to make those enhancements. Researchers wanted these EDs to strengthen their universal suicide risk screening and use collaborative safety planning for patients at risk of suicide who were discharged from the ED.

Researchers included 2,761 patient encounters (1,391 were men, mean age = 37.4 years). The authors reported declines in incidence of suicidal attempts, ideation, and behavior across each study phase. “Using CQI methods to implement a department-wide change in suicide-related practices, including the implementation of a safety plan intervention, yielded a significant decrease in suicide behaviors in the maintenance period of the study,” the authors wrote.

Suicide is the 12th leading cause of death in the United States, with more than 45,000 deaths in 2020 and a staggering 1.2 million attempts that same year. An estimated 90% of those who died by suicide had a diagnosable mental health condition at the time of death.

Between 2016 and 2020, the average annual ED visit rate for patients with suicidal ideation was 40 visits per 10,000 people, with rates higher for men than women. These visits occurred more often in departments located in the Midwest and West.

For more on this and related subjects, be sure to read the latest issues of ED Management.