Pisani Anthony R, Boudreaux Edwin D
Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux).
Focus (Am Psychiatr Publ). 2023 Apr;21(2):152-159. doi: 10.1176/appi.focus.20220081. Epub 2023 Apr 14.
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.
当代自杀预防方法不仅局限于个体与医疗服务提供者的互动，还拓展至在更广泛的医疗系统中寻找改进机会。基于系统的分析能够为改善整个医疗连续过程中的预防和康复工作带来契机。本文以一名在急诊科寻求治疗的个体为例，展示如何依据EPIS（探索、准备、实施、维持）框架的外部和内部背景，构建传统的临床病例分析，以阐明系统因素对结果的影响，并识别改进机会。文中概述了自杀预防系统方法的三个相互强化的领域（安全与预防文化；最佳实践、政策和途径；以及劳动力教育与发展）及其定义特征。安全与预防文化需要积极参与、信息灵通的领导者将预防置于优先地位；将实际经验融入领导团队；并在注重康复和改进的恢复性公正文化中对不良事件进行审查。促进安全、康复和健康的最佳实践、政策和途径需要对流程和服务进行共同设计，并通过持续的衡量和改进不断发展。为了支持安全与预防文化以及对政策的关怀、有效应用，组织受益于对劳动力教育采取纵向方法。这包括一个共同的框架和语言；临床与实际经验合作的模式；支持持续学习以及新员工入职培训，而不是采用“一劳永逸”的方法，以便自杀预防培训始终是全体员工首要关注的问题。
