• Ann Emerg Med · May 2022

    Design and Implementation of an Agitation Code Response Team in the Emergency Department.

    • Ambrose H Wong, Jessica M Ray, Laura D Cramer, Taylor K Brashear, Christopher Eixenberger, Caitlin McVaney, Jeanie Haggan, Mark Sevilla, Donald S Costa, Vivek Parwani, Andrew Ulrich, James D Dziura, Steven L Bernstein, and Arjun K Venkatesh.
    • Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, CT. Electronic address: wongambrose@gmail.com.
    • Ann Emerg Med. 2022 May 1; 79 (5): 453464453-464.

    Study ObjectiveAgitation, defined as excessive psychomotor activity leading to violent and aggressive behavior, is becoming more prevalent in the emergency department (ED) amidst a strained behavioral health system. Team-based interventions have demonstrated promise in promoting de-escalation, with the hope of minimizing the need for invasive techniques, like physical restraints. This study aimed to evaluate an interprofessional code response team intervention to manage agitation in the ED with the goal of decreasing physical restraint use.MethodsThis quality improvement study occurred over 3 phases, representing stepwise rollout of the intervention: (1) preimplementation (phase I) to establish baseline outcome rates; (2) design and administrative support (phase II) to conduct training and protocol design; and (3) implementation (phase III) of the code response team. An interrupted time-series analysis was used to compare trends between phases to evaluate the primary outcome of physical restraint orders occurring during the study period.ResultsWithin the 634,578 ED visits over a 5-year period, restraint use significantly declined sequentially over the 3 phases (1.1%, 0.9%, and 0.8%, absolute change -0.3% between phases I and III, 95% confidence interval [CI] -0.4% to 0.3%), which corresponded to a 27.3% proportionate decrease in restraint rates between phases I and III. For the interrupted time-series analysis, there was a significantly decreasing slope in biweekly restraints in phase II compared to phase I (slope, -0.05 restraints per 1,000 ED visits per 2-week period, 95% CI -0.07 to -0.03), which was sustained in an incremental fashion in phase III (slope, -0.05, 95% CI -0.07 to -0.02).ConclusionWith the implementation of a structured agitation code response team intervention combined with design and administrative support, a decreased rate of physical restraint use occurred over a 5-year period. Results suggest that investment in organizational change, along with interprofessional collaboration during the management of agitated patients in the ED, can lead to sustained reductions in the use of an invasive and potentially harmful measure on patients.Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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