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Rajwani A, Clark N, Montalvo C. Understanding Best Practices in Implementation of Behavioral Emergency Response Teams Through a Scoping Review. J Am Psychiatr Nurses Assoc 2023; 29:375-388. [PMID: 35918889 DOI: 10.1177/10783903221114335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health care providers are at risk of suffering physical or emotional abuse from patients, family members, and visitors. This results in decreased job satisfaction, high turnover, increased rates of patient physical and pharmacologic restraint, and poor patient outcomes. Behavioral emergency response teams (BERTs) have proven effective in reducing workplace assaults directed at staff, reducing the rate at which behaviorally disruptive patients are physically or pharmacologically restrained and are associated with increased staff satisfaction. AIMS This scoping review seeks to highlight the best practices and limitations of BERT use with adult populations in hospital settings to guide future implementation across academic medical centers. METHOD A literature review was conducted using PubMed, Tisch Library, and Tufts University School of Medicine's search tool "Jumbo Search" to screen articles for a duration from 2000 to 2021. The review was conducted following PRISMA-ScR guidelines using three screens for the inclusion of papers most relevant to the review's aims. RESULTS BERTs are commonly implemented with trained medical staff. The most common interventions used by the BERTs are de-escalation techniques and education for staff about the incidents. Most BERT implementation involves a proactive screening protocol for identifying high-risk patients and a team-based approach. CONCLUSIONS BERTS are effective at reducing assaults directed at staff and are associated with increased staff satisfaction. Using a proactive process to identify high-risk patients for disruptive behavior in conjunction with a team-based response to behavioral emergencies, academic medical centers can decrease the use of physical restraints and increase staff satisfaction leading to a higher quality of care.
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Affiliation(s)
- Aliysa Rajwani
- Aliysa Rajwani, BDS, MPH, CPHQ, Tufts Medical Center, Boston, MA, USA
| | - Natalie Clark
- Natalie Clark, MPH, Tufts University, Boston, MA, USA
| | - Cristina Montalvo
- Cristina Montalvo, MD, MBS, Tufts Medical Center, Boston, MA, USA; Tufts University, Boston, MA, USA
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Hasselblad M, Morrison J, Kleinpell R, Buie R, Ariosto D, Hardiman E, Osborn SW, Nwosu SK, Lindsell C. Promoting patient and nurse safety: testing a behavioural health intervention in a learning healthcare system: results of the DEMEANOR pragmatic, cluster, cross-over trial. BMJ Open Qual 2022; 11:bmjoq-2020-001315. [PMID: 35131740 PMCID: PMC8823076 DOI: 10.1136/bmjoq-2020-001315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Based on clinical staff safety within a learning healthcare system, the purpose of this study was to test an innovative model of care for addressing disruptive behaviour in hospitalised patients to determine whether it should be scaled up at the system level. Methods The Disruptive bEhaviour manageMEnt ANd prevention in hospitalised patients using a behaviOuRal (DEMEANOR) intervention team was a pragmatic, cluster, cross-over trial. A behavioural intervention team (BIT) with a psychiatric mental health advanced practice nurse and a social worker, with psychiatrist consultation, switched between units each month and occurrences of disruptive behaviours (eg, documented violence control measures, violence risk) compared. Nursing surveys assessed self-perceived efficacy and comfort managing disruptive patient behaviour. Results A total of 3800 patients hospitalised on the two units met the criteria for inclusion. Of those, 1841 (48.4%) were exposed to the BIT intervention and 1959 (51.6%) were in the control group. A total of 11 132 individual behavioural issues associated with 203 patient encounters were documented. There were no differences in the use of behavioural interventions, violence risk or injurious behaviour or sitter use between patients exposed to BIT and those in the control group. Tracking these data did rely on nursing documentation of such events. Nurses (82 pre and 48 post) rated BIT as the most beneficial support they received to manage patients exhibiting disruptive, threatening or acting out behaviour. Conclusions The BIT intervention was perceived as beneficial by nurses in preparing them to provide care for patients exhibiting disruptive, threatening or acting out behaviour, but documented patient behaviour was not observed to change. Trial registration number NCT03777241.
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Affiliation(s)
| | - Jay Morrison
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Reagan Buie
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee, USA
| | - Deborah Ariosto
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin Hardiman
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Samuel K Nwosu
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Christopher Lindsell
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee, USA
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Lindsell CJ, Gatto CL, Dear ML, Buie R, Rice TW, Pulley JM, Hartert TV, Kripalani S, Harrell FE, Byrne DW, Edgeworth MC, Steaban R, Dittus RS, Bernard GR. Learning From What We Do, and Doing What We Learn: A Learning Health Care System in Action. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1291-1299. [PMID: 33635834 DOI: 10.1097/acm.0000000000004021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Different models of learning health systems are emerging. At Vanderbilt University Medical Center, the Learning Health Care System (LHS) Platform was established with the goal of creating generalizable knowledge. This differentiates the LHS Platform from other efforts that have adopted a quality improvement paradigm. By supporting pragmatic trials at the intersection of research, operations, and clinical care, the LHS Platform was designed to yield evidence for advancing content and processes of care through carefully designed, rigorous study. The LHS Platform provides the necessary infrastructure and governance to leverage translational, transdisciplinary team science to inform clinical and operational decision making across the health system. The process transforms a clinical or operational question into a research question amenable to a pragmatic trial. Scientific, technical, procedural, and human infrastructure is maintained for the design and execution of individual LHS projects. This includes experienced pragmatic trialists, project management, data science inclusive of biostatistics and clinical informatics, and regulatory support. Careful attention is paid to stakeholder engagement, including health care providers and the community. Capturing lessons from each new study, the LHS Platform continues to mature with plans to integrate implementation science and to complement clinical and process outcomes with cost and value considerations. The Vanderbilt University Medical Center LHS Platform is now a pillar of the health care system and leads the evolving culture of learning from what we do and doing what we learn.
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Affiliation(s)
- Christopher J Lindsell
- C.J. Lindsell is professor of biostatistics, associate director, Center for Clinical Quality and Implementation Research, director, Vanderbilt Institute for Clinical and Translational Research Methods Program, and co-director, Center for Health Data Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cheryl L Gatto
- C.L. Gatto is research assistant professor of biostatistics and associate director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Lynn Dear
- M.L. Dear is project manager, Learning Health Care System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reagan Buie
- R. Buie is health policy service analyst, Learning Health Care System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- T.W. Rice is associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, vice president for clinical trial innovation and operations, Vanderbilt Institute for Clinical and Translational Research, and medical director, Vanderbilt Human Research Protection Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jill M Pulley
- J.M. Pulley is research associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, and executive director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tina V Hartert
- T.V. Hartert is professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, director, Center for Asthma Research, assistant vice president for translational science, and Lulu H. Owen Chair in Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- S. Kripalani is professor of medicine, Department of General Internal Medicine and Public Health, director, Center for Clinical Quality and Implementation Research, and co-director, Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Frank E Harrell
- F.E. Harrell is professor and founding chair, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel W Byrne
- D.W. Byrne is senior associate in biostatistics and director, Quality Improvement and Program Evaluation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mitchell C Edgeworth
- M.C. Edgeworth was chief executive officer, Vanderbilt University Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, at the time this manuscript was written
| | - Robin Steaban
- R. Steaban is chief nursing officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert S Dittus
- R.S. Dittus is the Albert and Bernard Werthan Professor of Medicine, Division of General Internal Medicine and Public Health, senior vice president and chief innovation officer, Vanderbilt Health Affiliated Network, executive vice president for public health and health care, and senior associate dean for population health sciences, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee
| | - Gordon R Bernard
- G.R. Bernard is the Melinda Owen Bass Professor of Medicine, Department of Allergy, Pulmonary and Critical Care Medicine, executive vice president for research, senior associate dean for clinical sciences, and director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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