Background: A working group was created to look at the care of behavioral patients in the hospital. This group focused primarily on the rapid response teams (RRTs) related to behavioral emergencies in this patient population. Currently if a patient decompensates psychiatrically, rather than their psychiatric issue be addressed promptly, an RRT gets called and many a times a code grey ensues, one of the standardized Hospital Emergency Codes that alerts all staff to potentially or actively combative persons. As such, hospital resources and staff are not being utilized efficiently, proving to cause delays in patient care. We looked at getting a “new” team together to support the medical admitting residents (MARs) on the rapid responses of these patients focusing on an interdisciplinary team approach with hopes of addressing these incidents promptly and efficiently, bringing all appropriate resources to the bedside, and decreasing injuries among our team members and patients. The creation of this new team was named the Behavioral Emergency Response Team (BERT) which went live on October 31st, 2022.
Purpose: To identify the process for activation and deployment of the Behavioral Emergency Response Team (BERT), to initiate de-escalation, assessment, and treatment of individuals who are experiencing a psychiatric emergency. The rationale for a BERT is to provide immediate de-escalation and care by an interdisciplinary team to prevent harm to patients and/or staff members.
Description: The team consists of the team caring for the patient, MAR, security officers, nurse manager or designee, patient engagement specialist and psychiatrist. This team will be activated for patients who decompensate solely psychiatrically as evidenced by signs of aggression, agitation, self-injury, and/or combativeness. When a behavioral emergency arises, a staff member will initiate the BERT by calling the operator who will then verbally page overhead “Behavioral Emergency Response Team” and the location three times.Just like rapid responses, the first provider to arrive on scene will assume the role of team lead. The BERT will be available 24 hours per day, seven days per week and team members are expected to arrive within 5 minutes of activation to provide further assessment, de-escalation, and treatment to the adult patient. The BERT will cover all inpatients except for those in the intensive care units and the operating room. A team member will document the events in the electronic medical record.
Conclusions: Within the first two weeks of the initiation of the BERT, we have already seen a significant drop in code greys dropping from roughly twenty code greys a week down to less than ten. Over the next few months, we hope to see the care of these patients deteriorating psychiatrically be addressed more promptly and thoroughly, resulting in a sustained drop in code greys and ultimately a decrease in staff injuries promoting a safer environment for all.