Volume 64, September 2022, 101199Abstract

Almost half (48,5%) of all individuals who die by suicide visited the Emergency Department (ED) in the year preceding their death by suicide and for almost a third (29,5%) of these individuals, the ED visit occurred within the month preceding their death by suicide. The ED is a key location for suicide prevention. The aim of this study was to develop and reach a consensus on the SecUrgence Protocol, a clinical protocol that intends to assess and provide care for individuals at risk of suicide that present themselves to the ED. This project was conducted in 3 stages: 1) Review of the literature, 2) Development of the list of the protocol statements by a first panel of experts, and 3) Validation, using the Delphi consensus method, on the final statements to include in the SecUrgence Protocol by a second panel of experts. Two rounds of the Delphi questionnaire were conducted until a final consensus of over 75% was reached. The SecUrgence Protocol is a first scientific step towards improving suicide prevention in the ED in Quebec as it was validated by a rigorous research process that included a consensus by all key stakeholders.

Section snippetsBackground

Suicide is a major public health concern worldwide [1]. Every year, more than 700 000 individuals die from suicide and even more individuals attempt suicide [1]. Internationally, suicide represents 1 in every 100 deaths and are on the rise in the Americas [2]. In Quebec, every year, 1054 individuals die by suicide, which represents an average of 3 deaths by suicide every day [3]. Around 28 000 individuals also attempt suicide every year, which represents an average of 76 individuals per day [4]

Study design

The Delphi method is generally used to obtain consensus from expert opinions in a field of interest. This method has been used to obtain consensus from expert panels for many protocols to date and has been proven to be successful in the field of mental health [14]. Delphi studies usually consists of two or more rounds or questionnaires that aim to rate or rank statements in order to reach consensus [17]. The process ends when consensus is reach for some or all items [17]. This project was

Results

In this study, 10 participants took part in the first expert group and 23 participants took part in the second expert group. From the second expert group, 23 participants completed the first round of the Delphi questionnaire and 16 participants completed the second round. The Table 2 describes the characteristics of the experts. This drop in participation, despite reminders and due date extensions, is common in Delphi studies [17]. Hence, the number and variety of experts that completed the

Discussion

This study allowed the development of the SecUrgence Protocol, which included 50 total statements. Consensus on this protocol was reached after two rounds of a Delphi expert panel. The SecUrgence Protocol is a significant step in services implementation science as it was validated by a rigorous research process that included a consensus by all ED key stakeholders, as recommended by Bernert et al. (2014) [10].

As previously mentioned, the SecUrgence Protocol is a response to an urgent need for

Limitation and strengths

This research project does have certain limitations. First, the literature review could have been conducted using a specific method such as the Scoping Review methodology or a systematic review methodology. Secondly, for the focus groups, social desirability may influence the exchanges and it may be difficult for some members to express themselves freely, especially considering that some members hold hierarchical positions. Some people may also speak more than others. That being said,

Conclusion

The SecUrgence Protocol has the potential to ensure an improved experience of care for patients at risk of suicide presenting to ED, their families, and hopefully contribute to a decrease in suicide rates. It is important to note that offering appropriate services at the right time and that meet the needs of patient is essential to prevent suicide and an important part of the SecUrgence protocol. Further work will include pilot implementation of the protocol in ED in Quebec and will be

Ethical statements

The CIUSSS de l'Estrie - CHUS Research Ethics Committee has approved this research project and is monitoring it. If you wish to contact a member of this committee, you can contact the CIUSSS de l'Estrie - CHUS Research Project Authorization Office at [email protected]gouv.qc.ca or 819–346-1110, extension 12 856.

Funding source

Jessica Rassy received a postdoctoral grant from the Quebec Network on Nursing Intervention Research (RRISIQ) and the project from the Réseau Québécois sur le suicide, les troubles de l’humeur et les troubles associés (RQSHA). Caroline Larue also received funding from the Centre de recherche de l’institut universitaire en santé mentale de Montréal (CRIUSMM) for this project.The grants supported data collection and analysis process. The funders had no role in the design of the study and

CRediT authorship contribution statement

Jessica Rassy performed Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Supervision, Validation, Writing - original draft. Alain Lesage performed Funding acquisition, Conceptualization, Investigation, Methodology, Resources, Supervision, Validation. Réal Labelle performed Funding acquisition, Conceptualization, Investigation, Methodology, Resources, Supervision, Validation. Farida Saadi performed Project administration, Resources, Writing - review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors would like to thank all members of the advisory committee for their valuable and constructive suggestions during the planning and development of this study.

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