Implementing a Behavioral Emergency Response Team to Improve Safety

Abstract

Problem: Behavioral emergencies are situations when a patient, family, or visitor displays behaviors that disrupt the function of the facility and/or present a threat to staff or others. At the University of Maryland Rehabilitation and Orthopedic Institute, the only current response to behavioral emergencies is to call a code green, which involves a “show of force” and “takedown” of the patient, during which the risk of being assaulted or injured is increased for all involved. From February 2021 to February 2022, 66 code greens were called for situations ranging from verbal assault to physical aggression. Purpose: The purpose of this quality improvement initiative is to implement a Behavioral Emergency Response Team (BERT) that can be utilized to de-escalate behavioral emergencies instead of calling a code green. The initiative was piloted over a 15-week period in the Fall of 2022 on the TBI and Cerebrovascular Accident units. Methodology: The BERT is a 24-hour resource which can be activated by calling the institution’s internal operator. Activation criteria includes yelling, cursing, demanding, threatening danger to self or others, unwanted physical contact, or sexual threats/assault. Data was collected on a weekly basis which included staff surveys on their ability to state how and when to activate the BERT, specific information related to a BERT activation (date, time, location, documentation), and specific information related to any Code Green activations. Staff training was completed via the institution’s password protected educational system and via an in-person session. Results and Conclusions: During the pilot implementation, there were five BERT and four Code Green activations. Documentation was 100% compliant for each activation and 86% of the staff were able to state the activation criteria and process for the BERT. By the end of the pilot, Code Green activations were decreased by 60%. These results show that utilization of the BERT is a beneficial asset in improving patient and staff safety.