Rapid Response Team for Behavioral Emergencies

St. Joseph Hospital, Orange, CA, USA, .
Journal of the American Psychiatric Nurses Association (Impact Factor: 0.98). 03/2010; 16(2):93-100. DOI: 10.1177/1078390310363023
Source: PubMed


Behaviors of patients with psychiatric illness who are hospitalized on nonbehavioral health units can be difficult to address by staff members. Instituting a rapid response team to proactively de-escalate potential volatile situations on nonpsychiatric units in a hospital allows earlier treatment of behavioral issues with these patients. The behavioral emergency response team (BERT) consists of staff members (registered nurses, social workers) from behavioral health services who have experience in caring for patients with acute psychiatric disorders as well as competence in management of assaultive behavior. BERT services were trialed on a medical pulmonary unit; gradual housewide implementation occurred over 2 years. Tools developed for BERT include an activation algorithm, educational cue cards for staff, and a staff survey. Results of a performance improvement survey reveal that staff nurses have had positive experiences with BERT but that many nurses are still not comfortable caring for psychiatric patients on their units.

    • "Such patients who are hospitalized on non-behavioral health units can be difficult to address by staff members. Thus, pressing the need for specialized staff like behavior emergency response team[22] to be instituted in future. In this study, it was found that maximum RRT activation were in oncology patients (41.46%) followed by cardiac and respiratory triggers (21.95% each). "
    [Show abstract] [Hide abstract] ABSTRACT: Rapid response team (RRT) has been implemented in developed countries with the aim of early recognition and response to critical care triggers for the better patient outcome. However, the data concerning their efficacy is hardly available until date from Indian subcontinent. To evaluate the impact of RRT implementation on patient outcome during medical emergencies. Retrospective observational study of RRT records of in-bed patients of super specialty academic teaching hospital. RRT record forms during the first half of the year from January 2012 to June 2012 were included for all inpatients and out-patients irrespective of their age, gender and diseases profile after their inclusion in the system. Outcomes such as patient stayed in the room, patient transfer to intensive care unit (ICU), patient discharge and generation of code blue event, mortality and length of stay in hospital/ICU were measured. Descriptive analysis was performed with the help of statistical software STATA 9.0 and R 2.13.2 (StataCorp LP, Lakeway Drive College Station, Texas, USA). Analysis of 41 RRT calls showed decreased code blue calls by 2.44% and decrease in mortality by 4.88%. Average length of stay in ICU and hospital post RRT assistance for patients was 2.55 and 6.95 days respectively. Conversely percentage of patients requiring a higher level of care was more (75.61%) than those who stayed in their rooms/wards (24.39%). Implementation of RRT in this hospital was associated with reduced code blue events and its attendant mortality outside the ICU settings. However, more number of patient requiring higher levels of care delineates the need for a larger evidence based medicine study.
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    • "Enhanced service models are common in emergency departments (ED): ED-based psychiatric emergency services (Woo et al. 2007), ED-based advanced practice nurses (Karshmer and Hales 1997, Wand and Fisher 2006), on call nurse liaisons (Wand 2004). The Behavioral Emergency Response Team, a rapid response team for psychiatric emergencies in non-behavioral healthcare settings, offers another care model that was successfully trialed in a setting where psychiatric nurses were available to assist staff working in non-psychiatric settings (Loucks et al. 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Aim. To report the development and psychometric testing of the Behavioral Health Care Competency survey, designed to measure hospital nurse perceptions of behavioral healthcare competency. Background. Hospital nurses working in general or other non-psychiatric units may lack behavioral healthcare competency to manage disruptive behaviours associated with mental illnesses. Design. Instrument development. Method. A nurse study team including clinical experts and nurse researchers from three community hospitals in southern California (USA) reviewed content validity of each item and the 31-item instrument and created a behavioral health care competency conceptual model based on the nursing process. Separate institutional review board permissions were obtained from each hospital. The study team collaborated in the timing of survey administration (November 2010), analysis of the results and survey validation. Results. A total of 844 nurses completed the survey, representing approximately 23–41% of eligible nurses from each hospital. Using principal component analysis with varimax rotation, 23 items led to a factor structure with four components. Four subscales with adequate alpha coefficients were formed: Resource Adequacy, Patient Assessment, Practice/Intervention Competency, and Psychotropic Recommendation. Conclusion. The 23-item hospital nurse Behavioral Health Care Competency survey is an adequate and valid newly developed instrument. Further testing with diverse samples is needed to strengthen generalizability and address unique and specialized nursing care needs.
    Full-text · Article · May 2012 · Journal of Advanced Nursing
  • [Show abstract] [Hide abstract] ABSTRACT: Current psychiatric nursing practice remains grounded in tradition, unsystematic trial and error, and authority. Although some of the wisdom that has been passed down over time is questionable, it continues to influence nursing practice today. This state-of-the-evidence review examined features of intervention studies published between January 2006 and December 2010 in five psychiatric nursing journals; it compared findings with those from a previous study of comparable literature published between 2000 and 2005. The analysis included studies that evaluated strategies, procedures, or practices that promote mental health or prevent mental illness. Of the 553 data-based articles, 71% tested interventions; 54% were conducted in the United States. Intervention studies reflected psychological (38%) social (17%), and biological (1%) dimensions of the biopsychosocial model. Some studies involved two dimensions and 17% included all three dimensions. Studies involved nurses, students, or staff (15%), mentally ill (50%), or mentally healthy persons (35%) ranging in age from childhood through older adulthood. The 10 year review showed continuing progress toward increased dissemination compared to earlier years; less focus on nurses, students, and staff; an increase in international studies; and greater emphasis on holistic interventions. In this article, the authors note a need for more randomized, controlled trials and studies to compare effectiveness across interventions.
    No preview · Article · Oct 2012 · Online journal of issues in nursing
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