385 - Implementation of a Behavior Response Team to decrease harm during pediatric admissions

Poster Number: 385
Publication Number: 385.243

Amanda Warniment, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Michael E. Schweer, Cincinnati Children's Hospital Medical Center, Bellevue, KY, United States; Lisa E. Herrmann, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; marykay duncan, Cincinnati Children's Hospital Medical Center, walton, KY, United States; Kimberly Whitesell, Cincinnati Children's Hospital Medical Center, Covington, KY, United States; Randall J. Edwards, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Li Lin, cincinnati children's hospital medical center, Cincinnati, OH, United States; Nancy Daraiseh, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jeffrey Simmons, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Angela Statile, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Children with aggressive behaviors are often hospitalized for medical and psychiatric conditions. These behaviors include outbursts, resistance to medical procedure participation, and elopement attempts that pose risk of self-harm or staff injury. Despite support from our institution’s Behavior Safety Team (BST) consult service (providers with de-escalation expertise), behavioral events and injuries occurred.

Objective: To implement a Behavior Response Team (BRT) on inpatient medical units to respond to patient behavioral events to increase days between Occupational Safety and Health Administration (OSHA)-recordable injury secondary to aggressive patient interactions and to improve employee perception of support over 1 year.

Design/Methods: We used quality improvement methods to design and implement a BRT of bedside providers, responders with de-escalation training, a nursing leader, protective services officer, and BST facilitator. Providers call a BRT Huddle to proactively develop a plan for patients showing early escalation signs or a BRT STAT for immediate help for active risk of harm to self or others. Key drivers were identified and informed interventions: 1) standardized roles, workflow and support tools, 2) provider education, 3) feedback and review process, and 4) debrief and support system post-events. Process (BRT events) and outcome (OSHA-recordable injuries) measures were followed on run charts over time. A pre-post implementation employee survey with Likert scale responses was analyzed using paired t-tests to assess employee perception of support.

Results: In the year following BRT implementation, an average of 13 BRT events occurred per month (Figure 1). Maximum days between OSHA-recordable events was 134 (Figure 2), with 2 of 6 events deemed to be BRT-preventable. The survey revealed improved confidence in caring for escalating patients and knowledge on how to obtain help, as well as support provided by BRT (p < 0.0001, Cohen d=0.22-0.46; Table 1).Conclusion(s): We implemented a BRT to respond to patient behavior events on inpatient medical units. Although we did not sustainably increase days between OSHA-recordable injuries, events were rare and most were not BRT preventable, indicating additional variables in the complex safety system contributed. Improved provider psychological safety and comfort with system supports when caring for children with behavioral risk are good first steps. Next steps include expanding de-escalation training while addressing larger system aspects to augment the BRT’s ability to prevent harm.
Figure 1. Process Measure: Number of BRT Events Over Time (Huddles and STATs)
Figure 2. Outcome Measure: Days Between OSHA-Recordable Injuries Due to Aggressive Patient Interactions