Suicide Assessment Follow-up Evaluation - Watch (SAFE-Watch)
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Formerly Suicide Risk Screen Follow-up Monitor (SRSFUM), SAFE-Watch supports suicide prevention as a top priority for Veteran's Health Administration (VHA)!
The Columbia Suicide Severity Rating Scale (C-SSRS) identifies Veterans at high risk for suicide and the Comprehensive Suicide Risk Evaluation (CSRE) assesses that risk and help define the next step of care.
SAFE-Watch is a safety net to ensure the CSRE is completed timely and helps prevent the potentially high-risk Veteran from walking out the door!
Origin:
May 2022, Colmery-O'Neil Veterans' Administration Medical Center (Topeka)
Adoptions:
41 successful
Awards and Recognition:
National HeRO Award, Recognized as the best practice and strength for our VISN by the VHA OMHSP team in their site visit., Diffusion of Excellence Promising Practice, VHA Shark Tan ... National HeRO Award, Recognized as the best practice and strength for our VISN by the VHA OMHSP team in their site visit., Diffusion of Excellence Promising Practice, VHA Shark Tank Winner, FedHealth IT Award
Partners:
Mental Health and Suicide Prevention
Recent Updates
Overview
The problem
The solution
Images
The results
Images
Metrics
- Before full implementation of SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) in VISN 15 of Suicide Risk Follow Up Monitor, the adherence for CSRE completion was 65% and VISN 15 ranked in the middle of all other VISNs. Following full implementation of all sites in VISN 15 (June 30, 2022); VISN 15 was the first to cross the 90% eCSRE1 Adherence Rate. VISN 15 continues to lead the nation in this metric. Project formerly known as Suicide Risk Screen Follow Up Monitor SRSFUM. (See Multimedia section below for VISN 15 Timeline Graph)
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Initiation (Timeline may vary)
Get buy in by Suicide Prevention Team (SPT) and Facility Leadership to include identifying a Suicide Prevention Coordinator (SPC) Champion and Clinical Applications Coordinator (CAC)/Health Information Specialist (HIS). -
60 Minutes
Provide training to VISN Lead SPC, Facility SPT and CAC/HIS. -
1 to 3 Days
Obtain necessary access:1. POPUP Flag Menu [R1ORPU MAIN MENU] for CAC/HIS only2. R1ORPU CSSRS FACILITY (security key) for Facility SPT and CAC3. R1ORPU CSSRS INTEGRATED (security key) for VISN Lead SPC and VISN LeadCAC/HIS4. C-SSRS FOLLOW-UP MONITOR [R1ORPU06] (menu) for VISN Lead SPC, FacilitySPT, VISN Lead CAC/HIS, Facility CAC/HIS -
Less than 5 Minutes
Ensure CPRS POPUP Parameter [ORWOR AUTO CLOSE PT MSG] is set to manual close CAC/HIS task – should have [XPAR EDIT PARAMETER] menu option. -
1 to 2 Hours
TESTING OF MENUs and KEYS in Test or Production VistA and CPRS per local testing guidelines. VISN Lead SPC, Facility SPT, VISN Lead CAC/HIS, Facility CAC/HIS -
1 to 2 Hours
Develop SOW per local facilityVISN Lead SPC, Facility SPT, Facility Leadership -
Ongoing
Implement and track the SAFE-Watch (Suicide Assessment Follow-up Evaluation -Watch) report. Tracking can be done through Risk ID Dashboard to monitor CSRE adherence completion rates and other locally developed tools and reports.
Departments
- Suicide prevention
Core Resources
Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Links
- Setup guide for Clinical Application Coordinator (CAC)/ Health Informatics Specialist (HIS) (Project formerly know as Suicide Risk Screen Follow-up Monitor-SRSFUM) SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) CPRS Popup and VistA Report setup guide
- Educational PowerPoint demonstrating use of the SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) and its effect on the eCSRE1 Adherence metric SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) Educational PowerPoint
- Install Guide for CPRS popup patch that includes the SAFE-Watch (Suicide Assessment Follow-up Evaluation -Watch) CPRS Popup and VistA report. YourIT Group for R1ORPU CPRS Popup Package: SPM.HEALTH.HISM.APP.FES.MUMPS.TRIAGE CPRS Popup patch R1ORPU 3_0_9 install guide
- Complete implementation guide for SAFE-Watch. Diffusion Implementation Guide 2024 SAFE-Watch
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
About
Origin story
Original team
Michael K Rogers
VISN Lead Clinical Applications Coordinator
Karen Baptiste
Clinical Applications Coordinator
Cheryl Meisinger
Clinical Applications Coordinator
Dr. Stephanie Davis
Suicide Prevention Manager
Evan Nelson
IT Specialist
Dr. Selvam Ayyasamy
VISN 22 Chief Medical Officer (Executive Sponsor January 2022- October 2024 - Shark Tank to Diffusion Summit)
Kevin DeZorzi
Division Manager, Field Enhancement & Sustainment VistA Division
Cary.Baker@va.gov
Clinical Application Coordinator, V21 Reno, NV Implementation Fellow
Dr. Stephanie Davis
Suicide Prevention Manager
Roberta.Mcmordie@va.gov
Suicide Prevention Coordinator; Reno, VA - Clinical Facilitated Replication Lead
Ahmad.Batrash@va.gov
VISN 15 Chief Medical Officer - Executive Sponsor of SAFE-Watch
Deborah Ernzen
Senior Data Analyst (Retired)
Now live in Fresno
Great news, Sean! Thank you for sharing and implementing SAFE-Watch. I added Fresno to the diffusion map.
Prescott VA is currently using this monitor and we have seen improvement in the last three months regarding the monthly ecsre1. Our SPC team, in conjunction with efforts from MH clinical improvement and Quality and Patient Safety , have developed a daily flow that appears to be working after learning from a pilot program that we tried earlier in the year. We hope to see the trend continue.
Thank you so much for sharing your comments and success! Our team looks forward to highlighting Prescott's success story in the future. Please keep sharing your successes! Contact the SAFE-Watch team with any questions. Have a wonderful day!
Albuquerque has officially initiated the monitor and we have gotten our first alert today! Also very grateful for Dr. Post's time and education, we have done extensive training with all of our staff regarding their closed loop communication. It is great that we can support our outpatient clinics this way, as well as catching direct admit transfers, unexpected post-procedure admits, discharge barriers, and just plain human error; there is a sieve of opportunity for misses. We had created our own manual process, but it was clunkier and required a few of us to scramble to diffuse the alerts as quickly as we could find them. This is so much smoother and allows for prompt communication across our teams.
Our Boise facility is in the process of implementing the +CSSRS monitor. On the very first day we practiced utilizing the tool (before we even officially began using it) our teams were able to identify what most certainly would have been a fallout, and then intervene to ensure a CSRE was completed same day. The success was extremely rewarding, and the teamwork and support that everyone felt was revitalizing. While I believe there'll always be a place for this kind of safety net, the goal as I see it is for the process to be one of education and support. We're hoping that through this process we're helping folks problem solve obstacles in ways that they will then utilize to manage future barriers on their own.
@ Julia Scott (thanks for your time talking today) AND other converted sites to Cerner: the Cerner EHR is better optimized already than what can be done with CPRS. specifically, the CSSRS screening Powerform which launches off recommendations (reminders) guides the screening staff after a positive screen, if they are not the one to complete the CSRE, to do closed loop communication meaning a warm-handoff about the positive screen to the provider for CSRE completion. this is similar to the screening pop-ups in CPRS with a similar message, but the form also validates the screener's entry of who they handed to, from a list of EHR users [which is not possible in CPRS], so all charted information has an added level of validity. furthermore, when there is a positive CSSRS a "Smart zone" alert is fixed in an area at the periphery of the screen for 24 hours to supplement the interprofessional communications in a much less intrusive manner (not intruding on the ability to use the workflow)--which makes all the difference in mitigating alert fatigue.
in my experience supporting information products and QI nationally in this area, this can easily create many serious problems in implementation. it clearly can de-emphasize the MANDATED person to person closed loop communication for ALL positive suicide screens. it is thus not directed to the dyad of screener and follow-up clinical staff member, rather it alerts many who interact with that patient chart. thus, it also adds to the global burden of alert fatigue which is an extremely serious problem in EHRs generally and CPRS in particular. therefore it is far from clear that this is a net positive on the multitude of clinical processes that transpire for any given patient.
I am interested in this platform, however we are a Cerner site. Any idea if this will work in Cerner? Thank you!
Hello Julia, thank you so much for your comment. I'm so happy you asked this question. Our team's goal is to find the way to ensure the Suicide Risk Screen Follow Up Monitor (SRSFUM) is available to all VA facilities. Currently, this product is only available to facilities using CPRS; however, our team is motivated to make this happen for Oracle Health to ensure our progress is not lost as facilities transition to our future EHR. If you would like to discuss, please use the email innovation button on this page. Our team is always happy to hear input and brainstorm ideas to develop Phase II to work with Oracle Health sites.
Reno is an Implementing Facility and I am one of the Fellows on the team. Within 3 days of going "live" with this monitoring tool, our team was able to catch and stop 2 fallouts. It has been a full week and one more potential fallout was stopped. Our team has been able to develop an effective way to support staff and warm-hand offs without them feeling like they were being micro managed and the Veteran receives the care they deserve without falling through the cracks.
Thank you for embracing this new practice and sharing your facility's success in the first week of go-live. We appreciate you taking the time to share how the tool is supporting VA staff and our Veterans.
I am interested in possibly implementing this at my facility, but I do have questions. I thought this metric had to be completed within 24 hours, so I am curious if that is true why the follow up at 36 hours would help you stay in compliance. Or have I been given incorrect information on the metric?
Thank you so much for your interest. You are correct about the 24 hours; however, when we tested the CPRS popup timing for "Suicide Risk Screen", we learned the "Suicide Risk Screen" popup stayed active for 36 hours if no action was taken to complete the "Comprehensive Suicide Risk Evaluation (CSRE)". For the benefit of the patient and standardization, we did not change the "Suicide Risk Screen Follow Up Monitor (SRSFUM)" to 24 hours. It was felt that a patient at 25 hours and 2 minutes has earned the same level of follow-up for their positive screen even if it is considered a fallout for eCSRE1. We have also found documentation errors, duplicate Suicide screens entered, and conflicting suicide risk screening results in the same record that were able to be corrected because of the 36 hours window. I hope this helps. Please email our project team using the "Email Innovation" button on this page with any questions. We are here to help.
I recently assumed the role of Suicide Prevention Program Manager at this facility, and at first I was so worried about keeping track of all of the details. Learning how to use this tool took about five minutes, and it gives me such peace of mind. I know at any given moment which of our Veterans has screened positive for suicide risk, and I can ensure we have a plan to follow up with each one.
I am fortunately one of the initializing team members. This is on my Top 10 as most important to the VA.