Assessment and Implementation of a Suicide Prevention Training in the Emergency Department

Aim: : Suicide is a leading cause of death in the United States and up to 43.8% of individuals who die by suicide have visited an Emergency Department (ED) in the year prior to their death. Current research supports the implementation of suicide prevention initiatives in the ED, however barriers such as staff knowledge of evidence-based practices exist. This project seeks to assess ED staff knowledge of suicide prevention before and after Counseling on Access to Lethal Means (CALM) training, in addition to the perceived effectiveness of the program. The project aim is to increase awareness about suicide prevention resources.

Framework:: The PDSA and IOWA Models were considered in the development of this project.

Setting:: This project was performed at an academic medical center in the Northeast. This Level I trauma center is the tertiary care center for a rural population of more than one million people.

Stakeholder Team:: This project was led by a Doctor of Nursing Practice student studying to become a Psychiatric-Mental Health Nurse Practitioner while working as an Emergency Department Nurse. Data analysis was provided by an Emergency Medicine Research team. The project was developed with feedback from mentors, a team of Emergency Department leadership, physicians, psychiatry, physician assistants, nurses, mental health technicians, emergency medical technicians, and local community health partners. Grant support was provided by a local nonprofit organization supporting suicide prevention work in Emergency Departments throughout the state.

Methods: : Suicide screening is not consistently performed using validated tools, so a survey was constructed to assess baseline knowledge, barriers to care, and offer an optional training intervention. All clinical ED staff at the selected facility (physicians, physician assistants, nurses, ED technicians, and mental health technicians) were offered voluntary participation in the project. Electronic pre-surveys were administered for baseline assessment, with a post-survey following CALM training. Sixty-four ED staff completed the training and both pre- and post-surveys. Demographic factors, including any history of suicide prevention training, were assessed in the initial survey. The surveys which accompanied the training were previously validated for this purpose and modified according to key stakeholder input.

Outcomes:: Our study showed a lack of baseline suicide prevention training among ED staff, with 78% reporting no prior suicide prevention training. Of the staff that participated in CALM training, there was a significant improvement ( < 0.001) in comfort and confidence regarding suicide risk assessment, utilizing means reduction approaches, and engaging in conversations around reducing access to lethal means.

Implications:: Suicide prevention training in the ED with evidence-based strategies such as CALM is a feasible component of ongoing ED staff training that demonstrates significant improvement in staff awareness, confidence, and belief in suicide prevention efforts. This preliminary quality improvement work will be utilized to inform the development of an upcoming institutional update to suicide care practices.