Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Contemp Clin Trials. 2020 Aug;95:106075. doi: 10.1016/j.cct.2020.106075. Epub 2020 Jun 19.
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.
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.
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.
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.
急诊科（ED）在预防自杀方面发挥着重要作用。历史上，许多有自杀风险的患者在常规临床护理中未被发现，而那些被发现的患者往往未接受专门针对自杀的干预。最初的急诊安全评估和随访评估（ED-SAFE1）研究考察了实施普遍的自杀风险筛查和多组分 ED 启动的自杀预防干预的情况。
ED-SAFE2 旨在研究使用持续质量改进方法（CQI）来改善与自杀相关的护理的效果，重点是改进成年 ED 患者的普遍自杀风险筛查，并评估将新的简短干预措施安全计划干预（SPI）纳入常规临床实践的情况。CQI 是一种质量管理过程，它使用数据和协作来推动渐进式、迭代式的改进。SPI 是一种个性化方法，重点关注早期识别警告信号并执行系统步骤来管理自杀念头。ED-SAFE2 将提供关于 CQI 程序在改善与自杀相关的护理流程方面的有效性的数据，以及这些改进对减少与自杀相关的结果的影响的数据。
使用阶梯式楔形设计，8 家 ED 在三个研究阶段（基线（回顾性）、实施（12 个月）和维持（12 个月））收集数据。精益方法，一种专门用于追求 CQI 的方法，侧重于增加价值和消除浪费，被用于评估和改善与自杀相关的护理。
这些结果将建立在 ED-SAFE1 的成功基础上，并通过促进更好的与自杀相关的护理流程和改进的自杀预防，产生广泛的公共卫生影响。
