(PS4-86) Suicide Prevention in Emergency Departments: Understanding Contextual Factors and Clinician Perspectives That May Impact Evidence-based Practice Implementation

Learning Objective: Attendees will gain a better understanding of clinician perspectives and the context of emergency departments for suicide prevention practice implementation.

Background: Despite the well-replicated efficacy of evidence-based practices (EBPs) for suicide prevention, these practices are rarely implemented with fidelity in emergency departments (EDs). This is important because research demonstrates that suicidal patients often present to EDs and that utilizing gold standard care for suicide prevention leads to lower inpatient admission rates, lower rates of suicidal behavior, and greater participation in outpatient care for these patients. Leveraging a larger trial that seeks to develop a suicide prevention consultation model for EDs, we surveyed ED clinicians to understand the context for implementation and their likely utilization of a consultation center to support care for suicidal patients in the ED.

Methods: We are surveying 40 mental health and ED clinicians employed across six EDs serving diverse patient populations in the Philadelphia metropolitan area. Clinicians complete validated, standardized measures of climate for EBP implementation in their workplace (18-item Implementation Climate Scale) and rate the degree to which their leader is supportive, knowledgeable, and prepared to implement EBPs (12-item Implementation Leadership Scale). Both measures were tailored for suicide preventions EBPs. We also are assessing norms, self-efficacy, attitudes, and intentions toward referring to a suicide prevention consultation center using standardized item stems from the Theory of Planned Behavior, rated on a 1 to 7 Likert scale. Data regarding structural characteristics of each ED, including size, average patient volume, and availability of mental health clinicians, are also being collected. 

Results: To date, data have been collected from 15 clinicians working in two EDs. Additional data collection is in progress and will be completed prior to the conference. Partner EDs serve diverse patient populations (47.6% white, 28.4% Black). Clinicians identified as predominantly white (80%) and male (60%). ICS total scores (M=1.3, SD=1.3) and ILS total scores (M=1.8, SD=0.9) were in the low-moderate range, indicating limited support for implementation of suicide prevention EBPs. Clinician norms, attitudes, self-efficacy, and intentions of utilizing the consultation center were favorable (M=6.1, SD=1.1). Analyses will be updated with data from four additional ED sites with 25 additional clinicians by the conference.

Discussion: Data collected and analyzed to date suggest that ED clinicians do not perceive their EDs as particularly supportive or conducive to the implementation of EBPs for suicide prevention in house; however, they would utilize a suicide prevention consultation center to facilitate access to suicide prevention EBPs for their patients. This work has the potential to increase our understanding of the context of EDs for suicide prevention, with the ultimate goal of reducing lives lost to suicide.