The ethics of proximity: Enrolling patients in emergency department hallway beds for suicide research.

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Suicide is the 10th leading cause of death in the United States. Prior research suggests that 10% of people who died by suicide received some form of emergency department (ED) treatment in the 2 months preceding death. The risk of attempted suicide is high during transition back to the community after discharge from the ED, so this is an important opportunity to develop effective empirically validated prevention methods. However, the physical layout and crowded nature of most contemporary EDs, resulting in high rates of "hallway bed" assignments, presents some ethical challenges to conducting the requisite behavioral health research in ED settings. In this report, we illustrate the clinical/research ethics controversy through the example of a specific ED-based suicide prevention research protocol, in which the proposed hallway bed recruitment was initially rejected by the institutional review board (IRB) based on concerns about privacy, data confidentiality, and related considerations. Through a consultation process that involved the IRB representatives, the research team (including ethicists), and ED personnel, along with the collection of data to evaluate the risk of compromised confidentiality in hallway bed settings, a viable and ethically grounded approach was reached. This example illustrates the ethical considerations when enrolling patients who occupy a hallway bed into research and the value of a collaborative/problem solving focused dialogue between investigators, ethicists, and IRB personnel.