Implementing Behavioral Optimization and Outcomes Support Team in a Medical/Surgical Telemetry Unit

Abstract

Problem: A community hospital reported about 21 staff assaults with injuries and 242 emergency response code green (CG) calls for violent behaviors resulting in lost time in the 2022 fiscal year. Evidence has shown that exposure to violent behaviors can compromise effective patient care and cause psychological distress, job dissatisfaction, high turnover, and higher healthcare costs. Purpose: The purpose of this quality improvement project was to develop and implement a behavioral optimization and outcome support team (BOOST) in a medical-surgical telemetry unit (MSTU) to reduce patient-to-staff assaults/injuries. Methods: The BOOST was piloted on the MSTU from October 2022 to January 2023. The process data includes staff knowledge and satisfaction with BOOST obtained with a pre-and post-implementation survey. The outcome data includes the number of BOOST calls, the number of CG calls, and the number of staff assaults/injuries. The BOOST is activated when a patient exhibits non-violent behaviors, and the team provides de-escalation and support. Data were collected weekly and analyzed using a run chart. Results: Twenty-six BOOST and 15 CG calls were activated during the 15 weeks of BOOST implementation. From week 4 to week 8, there was 100% BOOST call utilization in the MSTU. Survey data demonstrated an increase in knowledge of the behavioral response team among nursing staff. Staff respondents reported satisfaction with BOOST implementation, and they felt supported by the team. There were no staff injuries or assaults reported during BOOST implementation. Conclusion: BOOST calls were effective in the de-escalation of the patient and the team provided support to the nursing staff. BOOST utilization can effectively reduce assault and injuries in the workplace. Hospital spread and sustainability of BOOST should address the lack of BOOST knowledge among new nurses and staffing challenges in the behavioral unit.