ED-SAFE 2: Translating Safety Planning into Practice

 描述(申请人提供)：虽然急诊科(ED)一直被誉为自杀风险检测和预防工作的关键场所，但在常规临床护理中准确检测和有效管理自杀风险一直处于欠发达和研究不足的状态。急诊部安全评估和后续评估-2(ED-SAFE-2)是一个无与伦比的机会，可以研究成功实施的普遍自杀风险筛查的可持续性，以及在全国八家急诊室实施简短的自杀干预措施--安全计划干预--的可持续性。调查人员：项目团队在基于ED的自杀筛查、评估和管理(Boudreaux，Camargo，Miller，Manton)；安全规划(Stanley，Brown)；工业工程和医疗质量改进(QI)(Johnson，Pelletier，Dickson)；定性研究(Mattocks)；有效性试验设计和分析(Barton)；以及多中心自杀研究项目管理(Arias)方面拥有广泛的专业知识。该团队总共出版了100多份与自杀预防和构成领域有关的出版物。创新：除了率先在ED实施自杀风险筛查和安全规划并实现长期可持续性外，ED-SAFE-2将是首批使用系统、严格的方法研究名为精益的重要QI策略的机构之一。此外，它还将创新医疗服务研究方法，应用新的统计策略来分析阶梯形楔形设计的数据。方法：这项有效性试验将使用阶梯式楔形设计，使用8个原始ED-SAFE站点。将分三个阶段收集定量和定性数据：基线、实施和维护。目标1将衡量普遍自杀风险筛查(干预目标)的长期可持续性以及筛查对风险检测(患者结果)的影响。目的2将衡量临床医生管理的安全计划(干预目标)的有效实施以及安全计划对自杀和自杀相关的急性医疗保健(自杀综合结果)的影响。目标3将衡量和模拟安全规划的长期可持续性。此外，对于每个目标，将对精益的行动机制进行建模，包括组织特征和支持基础设施的变化。环境：随着最初的ED-SAFE和其他相关项目的成功，马萨诸塞州大学和合作机构已经清楚地建立了他们成功开展这项研究的能力。影响：这项研究将采用的创新方法将对自杀领域产生重大影响 预防、急诊医学、QI、有效性试验设计与分析。没有其他研究可以在一项研究中回答本申请中提出的所有重要研究问题。由于在其他环境下，包括住院、初级保健和专科护理在内的自杀风险筛查和管理研究面临着类似的挑战，因此交付成果将具有超越急诊环境的广泛意义。

 DESCRIPTION (provided by applicant): Although the emergency department (ED) has been heralded as a crucial setting for suicide risk detection and prevention efforts, accurately detecting and effectively managing suicide risk during routine clinical care has been under-developed and under-studied. The Emergency Department Safety Assessment and Follow-up Evaluation - 2 (ED-SAFE-2) represents an unparalleled opportunity to study both the sustainability of successfully implemented universal suicide risk screening and implementation of a brief suicide intervention, the Safety Planning Intervention, into routine care in eight EDs across the country. Investigators: The Project Team has extensive expertise in ED-based suicide screening, assessment, and management (Boudreaux, Camargo, Miller, Manton); safety planning (Stanley, Brown); industrial engineering and healthcare quality improvement (QI) (Johnson, Pelletier, Dickson); qualitative research (Mattocks); effectiveness trial design and analysis (Barton); and multi-center suicide research project management (Arias). Combined, the team has over 100 publications related to suicide prevention and constituent domains. Innovation: In addition to pioneering both the implementation and long-term sustainability of suicide risk screening and safety planning in the ED, the ED-SAFE-2 will be one of the first to study the prominent QI strategy called Lean using a systematic, rigorous approach. In addition, it will innovate healthcare services research methods by applying novel statistical strategies to analyze data from a stepped wedge design. Approach: This effectiveness trial will use a stepped wedge design with the eight original ED-SAFE sites. Quantitative and qualitative data will be collected across three phases: Baseline, Implementation, and Maintenance. Aim 1 will measure the long-term sustainability of universal suicide risk screening (intervention target) and screening's impact on risk detection (patient outcome). Aim 2 will measure the effective implementation of clinician-administered safety planning (intervention target) and safety planning's impact on suicide and suicide-related acute healthcare (suicide composite outcome). Aim 3 will measure and model long- term sustainability of safety planning. In addition, for each Aim, Lean's mechanisms of action will be modeled, including changes in organizational characteristics and enabling infrastructure. Environment: With the success of the original ED-SAFE and other relevant projects, UMass and the partnering institutions have clearly established their capability of successfully carrying out this study. Impact: The innovative approach to be employed in this study position it for a significant impact on the fields of suicide prevention, emergency medicine, QI, and effectiveness trial design and analysis. No other study can answer all of the important research questions posed in this application in one study. Because similar challenges face the study of suicide risk screening and management in other settings, including inpatient, primary care, and specialty care, the deliverables will have broad significance beyond the ED setting.