Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)

NCT ID: NCT01150994

Last Updated: 2019-03-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1440 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-07-31

Study Completion Date

2018-11-30

Brief Summary

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The NIMH s RFA-Suicide Prevention in Emergency Medicine Departments recognizes the emergency department (ED) as an important setting to increase suicide detection and prevention efforts but observes that evidence-based practice guidelines do not exist. In response, we have designed the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) trial. The ED-SAFE study will be conducted using a quasi-experimental design appropriate for studying systems-based change. The study consists of two components (Screening Outcome \& Intervention Evaluation) and three phases of data collection: Treatment as Usual, Screening Alone, and Intervention. During each phase, 480 suicidal patients (1,440 total) will be enrolled and followed using multiple methods for 12 months.

The Screening Outcome Component

The Screening Outcome component will use data collected during the Treatment as Usual and Screening Alone phases. Consistent with systems-change principles, when universal screening is incorporated during the Screening Alone phase, it will be completed by the primary nurse as part of routine care. Primarily, it will focus on testing a practical approach to screen ED patients for suicidal ideation and behavior and will assess its impact on suicide detection, process outcomes, and suicide behaviors.

Intervention Evaluation Component

The Intervention Evaluation component will use data from the Treatment as Usual, Screening Alone, and Intervention Phases. During the Intervention phase, each ED will implement a multi-component, systems-based Intervention called the Safety Assessment and Follow-up Telephone Intervention (SAFTI). The SAFTI will combine elements of: (a) safety planning administered by nursing staff in the ED, and (b) Coping Long Term with Active Suicide Program (CLASP)-ED, a series of up to 7 semi-structured telephone advising calls to the patient and 4 to the significant other over the 12 months after the ED visit. Safety planning will be implemented universally to all suicidal patients, regardless of whether they are ultimately enrolled into the trial, as part of a comprehensive suicide management protocol (e.g., it is a systems-based change). However, for practical and budgetary considerations, the CLASP-ED telephone advising calls will be administered only to participants enrolled into the study.

Our overarching hypotheses will be tested using a combination of the Screening Outcome component and the Intervention Evaluation Component. We predict that screening will improve detection of suicidal ideation, and the intervention will enhance the quality of care and reduce suicide outcomes.

Detailed Description

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see summary above

Conditions

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Suicide

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

SCREENING

Blinding Strategy

SINGLE

Participants

Study Groups

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Treatment as Usual

Group Type NO_INTERVENTION

No interventions assigned to this group

Screening Alone

Enhanced screening among ED patients

Group Type NO_INTERVENTION

No interventions assigned to this group

Safety Assessment and Follow-up Telephone Intervention

SAFTI: Safety Assessment in the ED combine with a Follow-up Telephone Intervention.

Group Type EXPERIMENTAL

Safety Assessment and Follow-up Telephone Intervention (SAFTI).

Intervention Type BEHAVIORAL

Mental health evaluation in ED, followed by Post-ED counseling

Interventions

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Safety Assessment and Follow-up Telephone Intervention (SAFTI).

Mental health evaluation in ED, followed by Post-ED counseling

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Over 18,
* Entering care at a hospital ED,
* Documented thoughts or behaviors related to self-harm.

Exclusion Criteria

* No phone or permanent address,
* Does not speak English or Spanish.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of Massachusetts, Worcester

OTHER

Sponsor Role lead

Responsible Party

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Edwin Boudreaux

Study Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Edwin Boudreaux, PhD

Role: PRINCIPAL_INVESTIGATOR

UMass Medical School

Carlos Camargo, MD, DrPH

Role: PRINCIPAL_INVESTIGATOR

Massachusetts General Hospital

Ivan Miller III, PhD

Role: PRINCIPAL_INVESTIGATOR

Butler Hospital

Locations

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Maricopa Medical Center

Phoenix, Arizona, United States

Site Status

University of Arkansas Medical Center

Little Rock, Arkansas, United States

Site Status

University of Colorado Hospital

Aurora, Colorado, United States

Site Status

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status

UMass Medical School, Marlborough Hospital

Worcester, Massachusetts, United States

Site Status

University of Nebraska Medical Center

Omaha, Nebraska, United States

Site Status

Ohio State University Medical Center

Columbus, Ohio, United States

Site Status

Memorial Hospital of Rhode Island

Pawtucket, Rhode Island, United States

Site Status

Countries

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United States

References

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Arias SA, Zhang Z, Hillerns C, Sullivan AF, Boudreaux ED, Miller I, Camargo CA. Using structured telephone follow-up assessments to improve suicide-related adverse event detection. Suicide Life Threat Behav. 2014 Oct;44(5):537-47. doi: 10.1111/sltb.12088. Epub 2014 Mar 3.

Reference Type RESULT
PMID: 24588679 (View on PubMed)

Betz ME, Sullivan AF, Manton AP, Espinola JA, Miller I, Camargo CA Jr, Boudreaux ED; ED-SAFE Investigators. Knowledge, attitudes, and practices of emergency department providers in the care of suicidal patients. Depress Anxiety. 2013 Oct;30(10):1005-12. doi: 10.1002/da.22071. Epub 2013 Feb 20.

Reference Type RESULT
PMID: 23426881 (View on PubMed)

Betz ME, Miller M, Barber C, Miller I, Sullivan AF, Camargo CA Jr, Boudreaux ED; ED-SAFE Investigators. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013 Oct;30(10):1013-20. doi: 10.1002/da.22075. Epub 2013 Mar 14.

Reference Type RESULT
PMID: 23495002 (View on PubMed)

Betz ME, Arias SA, Miller M, Barber C, Espinola JA, Sullivan AF, Manton AP, Miller I, Camargo CA Jr, Boudreaux ED. Change in emergency department providers' beliefs and practices after use of new protocols for suicidal patients. Psychiatr Serv. 2015 Jun;66(6):625-31. doi: 10.1176/appi.ps.201400244. Epub 2015 Mar 1.

Reference Type RESULT
PMID: 25726978 (View on PubMed)

Boudreaux ED, Miller I, Goldstein AB, Sullivan AF, Allen MH, Manton AP, Arias SA, Camargo CA Jr. The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): method and design considerations. Contemp Clin Trials. 2013 Sep;36(1):14-24. doi: 10.1016/j.cct.2013.05.008. Epub 2013 May 22.

Reference Type RESULT
PMID: 23707435 (View on PubMed)

Caterino JM, Sullivan AF, Betz ME, Espinola JA, Miller I, Camargo CA Jr, Boudreaux ED; Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) Investigators. Evaluating current patterns of assessment for self-harm in emergency departments: a multicenter study. Acad Emerg Med. 2013 Aug;20(8):807-15. doi: 10.1111/acem.12188.

Reference Type RESULT
PMID: 24033624 (View on PubMed)

Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012 Sep-Oct;34(5):557-65. doi: 10.1016/j.genhosppsych.2012.03.020. Epub 2012 May 2.

Reference Type RESULT
PMID: 22554432 (View on PubMed)

Ting SA, Sullivan AF, Miller I, Espinola JA, Allen MH, Camargo CA Jr, Boudreaux ED; Emergency Department Safety and Follow-up Evaluation (ED-SAFE) Investigators. Multicenter study of predictors of suicide screening in emergency departments. Acad Emerg Med. 2012 Feb;19(2):239-43. doi: 10.1111/j.1553-2712.2011.01272.x. Epub 2012 Jan 30.

Reference Type RESULT
PMID: 22288721 (View on PubMed)

Brown LA, Boudreaux ED, Arias SA, Miller IW, May AM, Camargo CA Jr, Bryan CJ, Armey MF. C-SSRS performance in emergency department patients at high risk for suicide. Suicide Life Threat Behav. 2020 Dec;50(6):1097-1104. doi: 10.1111/sltb.12657. Epub 2020 Jul 24.

Reference Type DERIVED
PMID: 32706437 (View on PubMed)

Boudreaux ED, Camargo CA Jr, Arias SA, Sullivan AF, Allen MH, Goldstein AB, Manton AP, Espinola JA, Miller IW. Improving Suicide Risk Screening and Detection in the Emergency Department. Am J Prev Med. 2016 Apr;50(4):445-453. doi: 10.1016/j.amepre.2015.09.029. Epub 2015 Dec 4.

Reference Type DERIVED
PMID: 26654691 (View on PubMed)

Other Identifiers

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1U01MH088278-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

13420

Identifier Type: -

Identifier Source: org_study_id

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