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The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): Method and design considerations
Open accessAbstract
Background Due to the concentration of individuals at-risk for suicide, an emergency department visit represents an opportune time for suicide risk screening and intervention.Purpose The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) uses a quasi-experimental, interrupted time series design to evaluate whether (1) a practical approach to universally screening ED patients for suicide risk leads to improved detection of suicide risk and (2) a multi-component intervention delivered during and after the ED visit improves suicide-related outcomes.Methods This paper summarizes the ED-SAFE's study design and methods within the context of considerations relevant to effectiveness research in suicide prevention and pertinent human participants concerns. 1440 suicidal individuals, from 8 general ED's nationally will be enrolled during three sequential phases of data collection (480 individuals/phase): (1) Treatment as Usual; (2) Universal Screening; and (3) Intervention. Data from the three phases will inform two separate evaluations: Screening Outcome (Phases 1 and 2) and Intervention (Phases 2 and 3). Individuals will be followed for 12 months. The primary study outcome is a composite reflecting completed suicide, attempted suicide, aborted or interrupted attempts, and implementation of rescue procedures during an outcome assessment.Conclusions While 'classic' randomized control trials (RCT) are typically selected over quasi-experimental designs, ethical and methodological issues may make an RCT a poor fit for complex interventions in an applied setting, such as the ED. ED-SAFE represents an innovative approach to examining the complex public health issue of suicide prevention through a multi-phase, quasi-experimental design embedded in 'real world' clinical settings.
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“using common continuous quality improvement (CQI) strategies, it was feasible to increase suicide screening to reach, on average, 85% of the adult ED population across eight diverse EDs”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [9]
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Suicide Prevention in an Emergency Department Population: The ED-SAFE Study
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Metadata
- Authors
- Boudreaux, E. D., Miller, I., Goldstein, A. B., Sullivan, A. F., Allen, M. H., Manton, A. P., Arias, S. A., & Camargo, C. A.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Butler Hospital (US)
- National Institutes of Health (US)
- Massachusetts General Hospital (US)
- VA Rocky Mountain Network (US)
- Cape Cod Hospital (US)
- Corresponding author
- Boudreaux, Edwin D.
- Venue
- Contemporary Clinical Trials
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 36
- Issue
- 1
- Pages
- 14-24
- ISSN
- 1551-7144 (ISSN-L)
- PMC
- PMC3979300
- OpenAlex
- W2024562192
- Cited by
- 113
- References
- 25
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 10 · 2023: 10 · 2022: 5 · 2021: 5 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 15 · 2016: 8 · 2015: 6 · 2014: 5
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Contemporary Clinical Trials (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institute of Mental Health (U01MH088278)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- suicide risk screening, emergency department, universal screening, suicide prevention, complex interventions, interrupted time series design, quasi-experimental design, suicide attempts, suicide mortality, follow-up evaluation
- MeSH terms
- Suicide Prevention, Mental Disorders, Emergency Service, Hospital, Health Services Research, Humans, Mass Screening, Mental Health, Outcome and Process Assessment, Health Care, Research Design, Suicide
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