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In upper center of the image is a silhouetted heart that is gently falling into a "safety" net held by three human figures. 
The safety net is a representation of SAFE-Watch that provides timely follow-up care to Veterans who screen positive for suicide risk.

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!

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

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

Overview

The problem

The Suicide Risk Identification Strategy (Risk ID) was implemented by Veteran's Health Administration (VHA) in 2018 in an effort to standardize suicide risk screening and comprehensive suicide risk evaluation across all facilities. This national strategy outlines specific requirements for completion of a timely Comprehensive Suicide Risk Evaluation (CSRE) fo ... See more

The solution

SAFE-Watch provides a CPRS popup notification and real-time VistA report to identify patients that have a positive Columbia-Suicide Severity Rating Scale (C-SSRS) within the last 36 hours. The CPRS popup alerts the Suicide Prevention Coordinator (SPC) or Suicide Prevention team designee(s) a patient screened positive for suicide risk which requires the compl ... See more

Images

This image depicts view of SAFE-Watch popup as it appears in CPRS. Popup shows number of current positive CSREs with a time track of the oldest not competed CSRE pending less than 36 hours.

Suicide Risk Follow Up Monitor Pop Up CPRS

This image shows the real-time SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) report available to Suicide Prevention Coordinators (SPCs) or Designees in VistA.
The report displays:
Division logged into
Results of positive suicide screenings in the last 36 hours
Patient name 
last 4 social security number
date/time of positive screen 
provider who completed the positive screen
Report includes option to list completed positive screens in the last 36 hours

SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch) Real Time VistA Report

The results

In May of 2021, the adherence eCSRE1 rate for Eastern Kansas Health Care System (EKHCS) was 46%. After implementation of the SAFE-Watch (Suicide Assessment Follow-up Evaluation - Watch), EKHCS noted a 54% increase in one year by achieving a 100% completion rate in May 2022. They have maintained 100% adherence rate for 16 consecutive months.

Images

Line graph depicting Eastern Kansas Health Care System (EKHS) eCSRE1 rate versus the VISN eCSRE Adherence Rate. The VISN eCSRE1 rate is shown at the top of the graph in a white field with black type. The rate shown is 69%. The graph below shows the EKHS rates from January 2021 thru September 2021 with emphasis on May 2021 showing a 46% completion rate.

Eastern Kansas eCSRE1 Adherence Rate May 2021 Risk ID Dashboard

Line graph depicting Eastern Kansas Health Care System (EKHS) eCSRE1 rate versus the VISN eCSRE Adherence Rate. The VISN eCSRE1 rate is shown at the top of the graph in a white field with black type. The rate shown is 88%. The graph below shows the EKHS rates from October 2022 thru June 2023 with emphasis on May 2022 showing a 100% completion rate. Additionally, the graph shows EKHCS maintaining a 100% adherence rate for each month after May 2022 thru present - a total of 15 consecutive months (note this also includes July 2023 which is not shown on the graph)

Eastern Kansas eCSRE1 Adherence Rate May 2022 thru June 2023 Risk ID Dashboard

VISN 15 eCSRE1 Adherence Rate Timeline January 2021 thru July 2023

VISN 15 eCSRE1 Adherence Rate Timeline January 2021 thru July 2023

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)

Statuses

AR: Fayetteville VA Medical Center (Fayetteville, Arkansas) AZ: Bob Stump Department of Veterans Affairs Medical Center (Prescott) AZ: Tucson VA Medical Center (Tucson) CA: Fresno VA Medical Center (Fresno) CA: Martinez VA Medical Center (Martinez) CA: Palo Alto VA Medical Center (Palo Alto, California) CA: Sacramento VA Medical Center (Sacramento) CA: West Los Angeles VA Medical Center (West Los Angeles) GA: Carl Vinson Veterans' Administration Medical Center (Dublin) IA: Des Moines VA Medical Center (Des Moines, Iowa) IA: Iowa City VA Medical Center (Iowa City, Iowa) IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois) IL: Marion VA Medical Center (Marion, Illinois)
  • Started adoption on 06/2022, ended on 09/2023.
KS: Colmery-O'Neil Veterans' Administration Medical Center (Topeka)
  • Started adoption on 05/2022, ended on 09/2023.
KS: Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth)
  • Started adoption on 05/2022, ended on 09/2023.
KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita)
  • Started adoption on 05/2022, ended on 09/2023.
MA: Jamaica Plain VA Medical Center (Jamaica Plain) MI: Battle Creek VA Medical Center (Battle Creek) MI: Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor) MN: Minneapolis VA Medical Center (Minneapolis, Minnesota) MN: St. Cloud VA Medical Center (St. Cloud) MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 05/2022, ended on 09/2023.
MO: John J. Cochran Veterans Hospital (St. Louis John Cochran)
  • Started adoption on 06/2022, ended on 09/2023.
MO: John J. Pershing Veterans' Administration Medical Center (Poplar Bluff)
  • Started adoption on 06/2022, ended on 09/2023.
MO: Kansas City VA Medical Center (Kansas City, Missouri)
  • Started adoption on 05/2022, ended on 09/2023.
MT: Fort Harrison VA Medical Center (Fort Harrison) ND: Fargo VA Medical Center (Fargo) NE: Grand Island VA Medical Center (Grand Island) NE: Omaha VA Medical Center (Omaha, Nebraska) NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque) NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno) NY: Franklin Delano Roosevelt Hospital (Montrose, New York) PA: Erie VA Medical Center (Erie) PA: Wilkes-Barre VA Medical Center (Wilkes-Barre) PH: Manila VA Clinic (Manila) SD: Fort Meade VA Medical Center (Fort Meade, South Dakota) SD: Hot Springs VA Medical Center (Hot Springs, South Dakota) SD: Sioux City VA Clinic (Sioux City) TN: Alvin C. York Veterans' Administration Medical Center (Murfreesboro) TN: Lt. Col. Luke Weathers, Jr. VA Medical Center (Memphis) TN: Nashville VA Medical Center (Nashville)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

  • 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 only
    2. R1ORPU CSSRS FACILITY (security key) for Facility SPT and CAC
    3. R1ORPU CSSRS INTEGRATED (security key) for VISN Lead SPC and VISN Lead
    CAC/HIS
    4. C-SSRS FOLLOW-UP MONITOR [R1ORPU06] (menu) for VISN Lead SPC, Facility
    SPT, 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 facility
    VISN 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
PEOPLE
  • Suicide Prevention Team; Suicide Prevention – pre implementation approximately 5 hours for 1 week post implementation approximately 2 to 3 hours/week
  • Facility Leadership/VISN SPC Lead - Leadership to assign staff with responsibilities and implement local process for timely monitoring and completion. Time will vary.
  • Clinical Applications Coordinator/Health Informatics Specialist (CAC/HIS); informatics – pre implementation: 1 to 2 hours post implementation: as needed for technical support
  • Service Line Automated Data Processing Application Coordinators (ADPACS): pre-implementation approximately 30 min to request appropriate keys and menus for end users using local process
  • VISN SPC Lead and Facility Leadership – as needed for pre implementation and post implementation support. Time will vary.
  • Office of Information Technology (OIT) - Staff to verify patch R1ORPU 3.0 * 9 is available or already installed. Pre-installation time: approximately 30 minutes. Post Installation time: As needed for technical support.
PROCESSES
  • When a positive Suicide Screen is entered a popup displays for Suicide Prevention Coordinator (SPC)
  • Continues to display for 36 hours or until a CSRE is entered for the patient
  • SPC runs VistA report to lookup patient specific information
  • SPC contacts clinical team to ensure a CSRE completion plan is in place
TOOLS
  • Software - VistA/CPRS

Links

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Clinical Applications Coordinator) Innovation adopter posted

Now live in Fresno

1
VA User (Psychologist Anthem CBOC – MHBS) posted

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.

VA User (QSV, Quality Specialist) Innovation adopter posted

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.

1
VA User (Suicide Prevention Coordinator) Innovation adopter edited

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.

1
VA User (Physician) posted

@ 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.

1
VA User (Physician) posted

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.

VA User (Health System Specialist) posted

I am interested in this platform, however we are a Cerner site. Any idea if this will work in Cerner? Thank you!

VA User (Suicide Behavior Program Coordinator) Innovation adopter edited

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.

4
VA User (VISN 19 Data Analyst) posted

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?

1
VA User (Psychologist) posted

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.

5
VA User (Program Analyst (Informatics)) Innovation owner posted

I am fortunately one of the initializing team members. This is on my Top 10 as most important to the VA.

1

About

Origin story

According to the eCSRE1 metric, VISN 15 facilities were not ensuring timely evaluation of 100% of positive Suicide Screens; in 2021 the VISN 15 eCSRE1 adherence rate was 70%. Although clinical staff receive education about requirements for timely Comprehensive Suicide Risk Evaluation (CSRE) completion following a positive suicide screen, potential gaps were ... According to the eCSRE1 metric, VISN 15 facilities were not ensuring timely evaluation of 100% of positive Suicide Screens; in 2021 the VISN 15 eCSRE1 adherence rate was 70%. Although clinical staff receive education about requirements for timely Comprehensive Suicide Risk Evaluation (CSRE) completion following a positive suicide screen, potential gaps were identified in the form of increasing clinical demands, human error, staff turnover, and inconsistent processes. Suicide Prevention teams were seeking real-time notification of positive suicide screens across the facility to ensure timely CSRE follow up.

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)