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UMass Chan suicide prevention study explores telehealth to improve outcomes, efficiency

A UMass Medical School researcher is leading a new study to evaluate the use of telehealth to improve suicide-related outcomes.

The four-year, $4.4 million National Institute of Mental Health effectiveness-implementation trial, called Telehealth to Improve Prevention of Suicide (TIPS) in emergency departments, focuses on interventions in community or rural hospitals. But these protocols could also be used in any emergency care setting, especially those without readily available mental health specialists.

Edwin Boudreaux, PhD

“Part of the foundation of this work is the observation that most emergency departments don’t really have enough behavioral health clinicians to adequately staff the department at all times,” said principal investigator Edwin Boudreaux, PhD, professor of emergency medicine.

As a result, patients in crisis may wait hours to be evaluated. Or they may be medically evaluated, but then transferred to another facility for mental health assessment. Clinicians, typically masters-level behavioral health specialists, may not be trained in best-practice suicide risk assessment and other new approaches, such as personalized safety planning. They may discharge the patient without evidence-based follow-up care that studies such as Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)  have shown can reduce total suicide attempts by up to 30 percent.

While COVID-19 has rapidly increased use of telehealth, Dr. Boudreaux said, “We still don’t really know the best way to implement it. We’re looking at whether we can train the people who are doing the evaluations on the best practices to improve the quality of care delivered by telehealth and whether we can implement a follow-up program that can apply the ED-SAFE intervention in an efficient, cost-effective way.”

The study will also evaluate system parameters, he said, by exploring questions such as:

  • Are hospitals with the telehealth intervention able to evaluate more people and can evaluations be done more quickly?
  • Will consulting a psychiatrist through telehealth to evaluate patients with a preliminary decision to be hospitalized reduce inpatient utilization among those who could be managed with outpatient care?
  • How does evaluating patients for suicide risk in the emergency department instead of transporting them to another site affect workflow for other emergency services?

The study applies telehealth interventions to emergency departments at UMass Memorial Medical Center Memorial Campus and UMass Memorial HealthAlliance - Clinton Hospital, which do not have on-site behavioral health specialists. UMass Memorial - Marlborough Hospital and UMass Memorial HealthAlliance - Clinton Hospital, Leominster Campus serve as nonintervention control emergency departments.

Data from Oct. 2017 to Sept. 2020 for all patients who screened positive on a universally administered, evidence-based screening tool or who received a mental health evaluation in the four emergency departments provide a historical control.

The second phase, rolling out over the next few months and continuing for two years, implements the TIPS telehealth protocol into routine clinical care for the two intervention emergency departments. All patients who screen positive for suicide risk or who require an emergency mental health evaluation in the intervention hospitals will be evaluated by telehealth, with the enhanced suicide risk assessment, safety planning and improved discharge planning, according to Boudreaux.

About 50 percent of patients screened in the intervention emergency departments will be provided with post-emergency visit counseling for about three months using the ED-SAFE protocol.

Best practices will be measured through a combination of electronic health record data downloads; chart reviews; and interviews with patients, families and clinicians.

Boudreaux said that data on the interventions’ impacts on suicide prevention would accrue over a few years. System-level impacts would be available sooner. Researchers are eager to understand the nuances of whether and under what conditions telehealth, enhanced training and follow-up counseling work best, to support the program’s potential use in other emergency departments.

Related stories on UMassMed News:
LISTEN: Edwin Boudreaux on screening for suicidal risk in ER patients
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Study: Suicide screening, interventions in emergency department can save lives