Introduction: 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.
\nMethods: 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.
\nResults: 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.
\nConclusion: 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.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"suicidality"},{"word":"Implementation Science"},{"word":"emergency department"},{"word":"behavioral health"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0ng2107g","frozenauthors":[{"first_name":"Ashlyn","middle_name":"","last_name":"Burns","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""},{"first_name":"Lauren","middle_name":"","last_name":"O'Reilly","name_suffix":"","institution":"Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana","department":""},{"first_name":"Elizabeth","middle_name":"","last_name":"Linhart-Espino","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""},{"first_name":"Katherine","middle_name":"","last_name":"LeFevre","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""},{"first_name":"Zachary","middle_name":"","last_name":"Adams","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""},{"first_name":"Rachel","middle_name":"","last_name":"Yoder","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""},{"first_name":"Paul","middle_name":"","last_name":"Musey","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":""},{"first_name":"Casey","middle_name":"","last_name":"Pederson","name_suffix":"","institution":"Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana","department":""}],"date_submitted":"2025-08-06T14:33:29.293000Z","date_accepted":"2025-12-06T14:47:14.679000Z","date_published":"2026-03-13T16:11:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/50581/galley/49060/download/"}]}