title: Improving Suicide Risk Screening and Detection in the Emergency Department.
abstract: BACKGROUND
  The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED).
  
  
  METHODS
  A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014.
  
  
  RESULTS
  Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ(2) [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ(2) [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview.
  
  
  CONCLUSIONS
  Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.
  
  
  BACKGROUND
  Emergency Department Safety Assessmentand Follow-up Evaluation (ED-SAFE) ClinicalTrials.gov: (NCT01150994). https://clinicaltrials.gov/ct2/show/NCT01150994?term=ED-SAFE&rank=1.
authors.affiliation: Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: edwin.boudreaux@umassmed.edu.
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Psychiatry and Human Behavior, Butler Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Arias
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: University of Colorado Depression Center and Rocky Mountain Crisis Partners, Aurora, Colorado.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Allen
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, NIH, Bethesda, Maryland.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Goldstein
authors.affiliation: Cape Cod Hospital/Centers for Behavioral Health, Cape Cod, Massachusetts.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Manton
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Espinola
authors.affiliation: Department of Psychiatry and Human Behavior, Butler Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Ivan W
authors.initials: IW
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment / Q000379:methods; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000517:prevention & control; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control; D055815:Young Adult; D000092864:Suicide Prevention