Implementing a nurse-led safety planning intervention in emergency departments to prevent suicide reattempts: a stepped-wedge randomized controlled trial protocol (French multicentre randomized controlled trial with a stepped-wedge design).

Suicide prevention is a worldwide challenge, and an emergency department (ED) visit is a key moment to prevent subsequent suicide risk. Previous studies reported the effectiveness of safety plan interventions (SPI), which are recommended by the suicide prevention resource centre and various health ministries. The safety plan encompasses a range of strategies to prevent and manage suicidal thoughts and actions. Our study (PROTECT) aims to evaluate the effectiveness of the SPI before patient discharged after suicide attempt by nurses and other health care professionals in the ED. Secondly, we will examine the implementation of the intervention among healthcare professionals and patients. The primary outcome is the reduction of suicidal behavior at six months, including suicide reattempts and death by suicide, after the index suicide attempt in patients who received the SPI compared to those who received the practices as usual. The effectiveness of the SPI will be evaluated through a multicenter stepped-wedge cluster randomized controlled trial. 2,387 people who have attempted suicide will be identified in 20 EDs and will first be observed during a control phase. The control group (observation phase) is defined by the administration of usual practices, which include the suicidal recontact program (Vigilans) combined with specialized follow-up tailored to each patient. Initially, the research teams will train emergency professionals in the use of the SPI (transition phase). Finally, an intervention phase will be activated during which the SPI will be implemented in addition to practices as usual. PROTECT is the first study to largely evaluate the effectiveness of the SPI and is the first ongoing study with a large number of included participants and participating centres. Significant findings may aid in the adoption of novel nursing care approaches to prevent suicide reattempts in the ED. The present trial has been registered on the ClinicalTrials.gov database (NCT05609487) since 8 November 2022.