Feasibility of Implementing Evidence-based Practices for Suicidality Management in the Emergency Department

TL;DR

This study explores the challenges and opportunities for implementing evidence-based practices for managing suicidality in emergency departments.

Contribution

The paper introduces a novel application of the Organizational Readiness for Innovation Implementation Framework to assess implementation feasibility in EDs.

Findings

Barriers to implementation include lack of resources, resistance to change, and competing demands in the ED.

Facilitators include openness to training, leadership support, and a desire to improve patient experiences.

Mixed attitudes among ED clinicians suggest a need for a multifaceted approach involving training and collaboration with behavioral health specialists.

Abstract

Best practice recommendations and guidelines for the assessment and management of suicidality within the emergency department (ED) have recently been updated. Despite national efforts to improve the management of suicidality in the ED, evidence-based practices remain underused with varied uptake among EDs and clinical team members. Given that the ED is a common point of entry for many people with suicidality, implementation of evidence-based strategies are needed to increase access to these strategies and improve patient outcomes.

To generate insights about the feasibility of implementing evidence-based practices for suicidality management, we developed a semi-structured interview guide focused on factors expected to influence the implementation process using a novel application of the Organizational Readiness for Innovation Implementation Framework. Working from a list or 80 EDs in the state of Indiana, we recruited emergency physicians, nurses, physician assistants, and social workers to participate in interviews. Interviews lasted approximately 45–60 minutes and were recorded, transcribed, and qualitatively analyzed using a multistage thematic analysis process.

We conducted 11 interviews with ED clinical team members from eight EDs in Indiana, representing 10% of the 80 EDs invited to participate in our study. Identified barriers to effective implementation included a general lack of resources, resistance to change among clinical team members, and competing demands in the ED setting. Facilitators included openness to attending training, openness to implementing change in the ED, and leadership support. Openness to change and commitment to change appeared to be driven by discontent with current processes and a desire to improve patient experiences.

Considering mixed attitudes toward suicidality management and questions about whether these services are within the scope of clinicians who work in the ED, efforts to increase uptake of evidence-based practices may involve a multifaceted approach that involves identifying and training team members who are open and ready for change, while simultaneously establishing stronger relationships between ED clinical team members and behavioral health clinicians with specialized training who can provide consultative services in the ED.

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