Development of a Repeat Suicide Risk Management Protocol for Emergency Department Patients With Suicide Attempts: An Exploratory Sequential Mixed-Methods Study.

The emergency department serves as the first point of contact for patients who have attempted suicide, playing a crucial role in identifying and managing their risk of subsequent suicide behaviours. However, evidence-based protocols for managing the repeat suicide risk are currently lacking in Chinese emergency departments. This study aimed to develop a preliminary, evidence-informed protocol for managing repeat suicide risk among emergency department patients who have already attempted suicide. A two-phase exploratory sequential mixed-methods design was employed. Phase 1 involved evidence synthesis and semi-structured interviews to develop a preliminary protocol draft. Phase 2 utilized a two-round Delphi expert consultation to revise and finalize the protocol. In the first phase, three themes were identified: behavioural attitudes toward suicide prevention, subjective norms of significant others and perceived behavioural control among healthcare providers. In the second phase, 19 experts completed two rounds of Delphi consultation. This resulted in a consensus protocol with 4 primary indicators (organiszational support, safety assurance, suicide assessment and intervention measures), 12 secondary indicators and 38 tertiary indicators. The expert panel demonstrated good authority and coordination (Cr = 0.927, Ca = 0.958), achieving a high level of consensus (Kendall's W = 0.292 and 0.385, p < 0.001) across two rounds. The risk management protocol developed in this study is actionable and focused. It provides a valuable reference for future clinical practice and related research in managing repeat suicide risk among such patients.