University of Massachusetts Medical School Faculty Publications


Emergency department safety assessment and follow-up evaluation 2: An implementation trial to improve suicide prevention

UMMS Affiliation

Department of Emergency Medicine; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Emergency Medicine | Health Services Administration | Health Services Research | Mental and Social Health | Patient Safety | Psychiatry | Psychiatry and Psychology


BACKGROUND: 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.

PURPOSE: 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.

METHODS: 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.

CONCLUSIONS: 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.


Implementation science, Mental health, Quality improvement, Suicide, Suicide prevention

DOI of Published Version



Boudreaux ED, Haskins BL, Larkin C, Pelletier L, Johnson SA, Stanley B, Brown G, Mattocks K, Ma Y. Emergency department safety assessment and follow-up evaluation 2: An implementation trial to improve suicide prevention. Contemp Clin Trials. 2020 Aug;95:106075. doi: 10.1016/j.cct.2020.106075. Epub 2020 Jun 19. PMID: 32565041. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Contemporary clinical trials

PubMed ID