In this episode, we discuss the primary outcomes of the ED-SAFE study, which assessed the efficacy of universal screening for suicidal ideation and brief intervention for SI among patients seen in medical emergency departments. Although these interventions (screening alone vs screening + brief intervention) were assessed in a multi-site trial, the authors do not perform a randomized clinical trial. Why not? How can we effectively assess systems-levels interventions? Can we trust the authors' conclusion that brief intervention is truly effective for decreasing suicide attempts in the year following the initial ED visit? We think so--listen in and see if you agree.