Behavioral Emergency Response Team: Proactive Violence Prevention Initiative in an Urban Hospital

Abstract

Problem: Workplace violence (WPV) is an ongoing problem in the healthcare field. According to the Occupational Safety and Health Administration (2015), from 2011 through 2013, U.S. healthcare workers suffered 15,000-20,000 workplace violence-related incidents resulting in severe injuries and time away from work for treatment. In a 179-bed urban hospital facility in Maryland catering to the needs of the inner-city population, there was a total of 103 WPV events between March 2021– May 2022. The use of combative patient code and security calls had increased significantly within the last year, especially in the 18-bed inpatient medicine unit. Due to this ongoing problem, there was increased verbal and physical assault on staff members, staff burnout and turnover, and poor patient outcomes such as restraint and forced medication usage. Purpose: This DNP quality improvement project aimed to evaluate the effectiveness of the implementation of a proactive violence prevention initiative called behavioral emergency response team (BERT) at an urban hospital facility in Maryland. Methods: The intervention was implemented over 15 weeks and piloted on the medical/surgical floor. A multidisciplinary team consisting of a crisis evaluator, psychiatric nurse, and security officer was created to respond to behavioral emergencies. BERT members received training on de-escalation techniques which included a mock code. Unit nurses completed the management of aggression and violence scale (MAVAS) to capture the perception of workplace aggression pre-and post-intervention. The number of WPV events and BERT calls, the response time and the type of intervention used was tracked. Results: A total of 6 BERT calls occurred during the implementation period. The most frequent intervention utilized by the team was verbal de-escalation, and the response time to the unit was all <15 minutes. Staff knowledge about BERT increased during the implementation period. Conclusion: Findings suggest that this Q.I. project will help de-escalate behavioral emergencies, reduce adverse patient outcomes, and increase the safety perception of staff members in the clinical setting.