Enhancing Patient Safety Through Simulation: A Randomized Control Trial of Suicide Prevention for Primary Care Providers-in-Training

Dates: 9/1/2015 - 8/31/2019


Role: Hugh F. Crean, PhD : Co-Investigator
Principal Investigator: Wendi Cross

This proposal responds to PA-14-004 Advances in Patient Safety through Simulation Research (R18). Suicide is a national public health crisis and a critical patient safety issue. It is the 10th leading cause of death overall and, tragically, the 2nd leading cause of death in adolescents and young adults (15-34 years old). Research consistently shows that about half of individuals who die by suicide had contact with primary care providers within one month of their death. Despite these data and the fact that the National Quality Forum designates patient suicide as a "never event" (i.e., an adverse event that is unambiguous, serious, and usually preventable), there is no required training in suicide prevention for healthcare providers. Patient safety is compromised when primary care providers lack the knowledge and skills to assess and respond to patients at risk for suicide. Given the fact that patients will continue to seek services in primary care, particularly early in the trajectory of symptoms and stressors (i.e., "upstream"), it is imperative that providers-in-training are educated in identifying and responding to individuals at risk for suicide. This randomized trial brings together three domains to improve patient safety: the latest science about suicide from a public health perspective, effective suicide prevention training that is grounded in adult learning theory using simulation methods, and the context of a changing health care landscape where primary care providers are likely to encounter suicidal individuals. Given the high rate of death by suicide for adolescents and young adults, we will focus on assessing and responding to this population. Participants (pediatric and family medicine residents, nurse practitioner students, n = 108) will be randomized to suicide prevention video-based didactics (control group) or didactics plus two standardized patient interactions with feedback (experimental group) with an adolescent and/or young adult scenario. Both conditions will be assessed for suicide prevention skills during a standardized patient interaction. We hypothesize that both conditions will show improved knowledge as a function of didactic training but that those who had the opportunity to interact with ‘at risk, suicidal standardized patients' will show better skills during the assessment, and report greater self efficacy, intention and actual use of suicide prevention skills with patients. We will also explore, for the experimental group, moderators as well as differences between face-to-face and telehealth patient interviews. If results support the efficacy of the program, training materials, measures, and methods will be disseminated and future studies will expand to other provider and patient populations.