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Elizabeth Mack, MD, MS, FCCM
Professor
Medical University of South Carolina, United States
Disclosure information not submitted.
Title: Reducing Workplace Harm through a Behavioral Rapid Response Team
Introduction: Patient behavioral events (PBE) contribute to patient and staff harm, job dissatisfaction, increased costs, and turnover. Inspired by the PBE cohort within Solutions for Patient Safety, we developed a pediatric inpatient behavioral event response team (PIBERT) composed of a pediatric intensivist, pediatric critical care nurse, chaplain, and security. This team was activated in May 2019.
Methods: A retrospective chart review was done to review patient safety events from May 2018 –April 2021, with related employee injuries requiring days away from work, restricted duty, or transferred to another unit (DARTs).
Results: Analysis of the May 2018-April 2019, the year prior to activation of our PIBERT team, there was no record of the number of PBEs, with an average of 1.31 DARTs per 200,000 hours worked. From May 2019-April 2020, there were a total of 11 PIBERT activations and 3.26 DARTs per 200,000 worked hours, and May 2020-April 2021 had 10 PIBERT activations, with 0.83 DARTs per 200,000 worked hours. While all 21 PIBERT activations were activated for patient agitation, 14 of those included physical and/or abuse towards staff, 4 for active elopement attempts, and 4 for attempts at self-harm and removal of medical devices.
Post-event surveys were sent to all responders to reflect on the efficacy of the response and to encourage reporting of harm. The majority perceived a timely response with the appropriate team members, and most responders also felt that the multidisciplinary team resolved the issue in a satisfactory manner. The most common suggested improvement was earlier activation of the PIBERT. Team members reported they spent a mean of 32 minutes with the event. Unfortunately, 46% of events involved an injury, and 7 reports were made of employee harm associated with these events. Fortunately, no responders perceived pushback to PIBERT activation.
Conclusions: In the first few years we focused on appropriate and timely activation, de-escalation, and increasing reporting of events. As with most quality improvement work, more accurate reporting may lead to an apparent increase in our DART rate. Moving forward, we are acting on the data collected through the debrief surveys, performing apparent cause analyses, and creating action plans to reduce barriers to activation or latent safety threats.