Suicidal Ideation, Suicide
Conditions
Keywords
Safety Planning, Emergency Department, Risk Assessment, Follow-up Contact, Implementation Strategies, Telehealth
Brief summary
The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments. We will compare implementation of the Safety Planning Intervention plus follow-up calls (SPI+) delivered by Emergency Department (ED) staff to SPI+ delivered via ED referral to an off-site Suicide Prevention Consultation Center (SPCC).
Detailed description
Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Patients are at increased risk of suicide attempts and suicide following an ED visit and nearly half do not attend outpatient treatment. Brief, evidence-based clinical interventions, such as the Safety Planning Intervention with post-discharge telephone follow-up (SPI+), can reduce suicide risk, decrease hospitalizations, and increase engagement in outpatient services for suicidal patients discharged from the ED. Leveraging insights from implementation science and collaborative care, we propose a model in which ED staff will connect patients at risk for suicide to ED-credentialed mental health clinicians who are located external to the ED. These off-site clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). All participating EDs will begin in the Enhanced Usual Care phase, in which ED staff will deliver SPI+ to suicidal patients. EDs will then be randomized in pairs to begin referral to the SPCC in 3 month intervals. We will also conduct a cost evaluation to help determine scalability and sustainability.
Interventions
BEHAVIORALSPI+ Delivered by ED Staff
ED staff will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) to patients at risk for suicide in the ED who are not admitted to an inpatient unit.
BEHAVIORALSPI+ Delivered by SPCC Clinicians
The Suicide Prevention Consultation Center (SPCC) will be located external to the Emergency Department (ED). ED staff will be able to refer patients at risk for suicide to the SPCC. Licensed and credentialed mental health clinicians will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) via telehealth to patients at risk for suicide in the ED who are not admitted to an inpatient unit.
Sponsors
University of Pennsylvania
National Institute of Mental Health (NIMH)
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Stepped-wedge cluster-randomized controlled design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aim 1/Aim 3: Inclusion Criteria: * ED visit at one of our participating sites for a suicide-related event or determined to be at risk for suicide per the Electronic Health Record (EHR) and ED clinical staff * 18 years of age or older * Not admitted to an inpatient hospital following the index ED visit as documented in the EHR
Exclusion criteria
\- Inpatient admission following the index ED visit per the EHR Aim 2: Inclusion Criteria: * ED clinician or leader at one of our participating sites, or ED patient who was referred to the SPCC * 18 years of age or older * Able to communicate in English * Willing to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Suicide Behavior Composite | 6 months after index ED visit | Number of patients who had a documented suicide attempt or death by suicide |
| Outpatient Treatment Engagement - Count | 6 months after index ED visit | Number of behavioral healthcare visits following discharge from index ED visit |
| Outpatient Treatment Engagement - Type | 6 months after index ED visit | Types of behavioral healthcare visits following discharge from index ED visit |
| Safety Planning Intervention Scoring Algorithm (SPISA) | At index ED visit | Fidelity of written safety plans post-discharge from index ED visit |
| Fidelity of Follow-up Calls | 1 month after index ED visit | Number of patients who had 2 or more follow-up calls post-discharge from index ED visit |
| Reach/Penetration of Safety Plans | At index ED visit | Proportion of patients with a completed safety plan documented in the medical record out of all patients identified as at risk for suicide by the ED staff |
| Reach/Penetration of Follow-up Calls | 1 month after index ED visit | Proportion of patients who receive 2 or more telephone follow-up attempts out of all patients who received a safety plan |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Suicide-related ED Visits and Psychiatric Hospitalizations | 6 months after index ED visit | Number of ED visits and/or inpatient psychiatric admissions for suicidal ideation/behavior |
| Suicide Attempts | 6 months after index ED visit | Number of patients who had a documented suicide attempt |
| Adoption | At index ED visit | Proportion of clinicians with eligible patients who refer the patient to the SPCC |
| Utilization of Screening of Suicide Risk Among ED Patients | At index ED visit | Proportion of ED patients who received the Columbia Suicide Severity Rating Scale or equivalent evidence-based measure of suicide risk during index ED visit |
| Index ED Visit Inpatient Admission Disposition | At index ED visit | Proportion of patients admitted for inpatient hospitalization out of all patients identified as at risk for suicide |
| Feasibility of SPCC | 9-12 months after ED crosses over to SPCC condition | Will be assessed through semi-structured qualitative interviews with a randomly selected sample of clinicians, leaders, and patients, as well as by using the Feasibility of Intervention Measure (FIM) |
| Acceptability of SPCC | 9-12 months after ED crosses over to SPCC condition | Will be assessed through semi-structured qualitative interviews with a randomly selected sample of clinicians, leaders, and patients, as well as by using the Acceptability of Intervention Measure (AIM) |
| Cost to Emergency Department of SPCC | After ED crosses over to SPCC condition (2.25 - 3 year range, average of 2.625 years) | We will assess average personnel and non-personnel costs to Emergency Department practices of delivering SPCC and EUC strategies, using Time-Driven Activity-Based Costing |
| Cost to Emergency Department of EUC | Before ED crosses over to SPC condition (1 - 1.75 year range, average of 1.375 years) | We will assess average personnel and non-personnel costs to Emergency Department practices of delivering EUC strategies, using Time-Driven Activity-Based Costing |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORGregory K Brown, PhD
University of Pennsylvania
Outcome results
None listed