Importance Suicide is a leading cause of deaths in the U.S. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. Objective To determine if an ED-initiated intervention reduces subsequent suicidal behavior. Design This multicenter study was composed of three sequential phases: 1) Treatment as Usual (TAU) (August 2010–December 2011), 2) Universal Screening (Screening) (September 2011–December 2012, and 3) Universal Screening + Intervention (Intervention)(July 2012-November 2013. Setting Eight EDs in the United States Participants Adults with a recent suicidal attempt or ideation were enrolled. Intervention Universal Screening consisted of universal suicide risk screening. The Intervention phase consisted of universal screening plus an intervention which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. Main Outcomes The primary outcome was suicide attempts (non-fatal and fatal) over the 52-week follow-up. The proportion and total number of attempts were analyzed. Results 1,376 participants (56% female, median age 36 years) were recruited. 288 participants (21%) made at least one suicide attempt. There were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and Screening phases (23% vs. 22%). However, when compared to the TAU Phase, subjects in the Intervention phase showed a 5 % absolute reduction in suicide attempt risk (23% vs. 18%) with a relative risk reduction of 20%. Participants in the Intervention Phase had 30% fewer total suicide attempts than participants in the TAU Phase. Negative binomial regression analysis indicated that the participants in the Intervention Phase had significantly fewer total suicide attempts than participants in the TAU Phase (IRR, 0.72, 95%CI 0.52–1.00, P=0.05), but no differences between the TAU and Screening phases (IRR, 1, 95%CI 0.71–1.41, P=0.99). Conclusions Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.

Introduction The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED). Methods A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014. Results Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ2 [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ2 [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview. Conclusions Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.