Background: The behavioral response team (BRT) at UNC Hospitals was established in 2015 and its purpose is to bring immediate resources to bear when hospitalized patients experience acute episodes of disruptive behavior that may cause harm to themselves or hospital staff. Our BRT is a multidisciplinary group consisting of a psychiatric nurse supervisor, medical nurse supervisor, and armed hospital security. The BRT works closely with patients’ primary medical teams throughout UNC Hospitals to de-escalate potentially volatile acute behavioral patient crises. BRTs are relatively new additions to inpatient healthcare and there is very little data on patient outcomes in the medical literature. Anecdotally, we do know that BRTs’ interaction with patients can potentially result in significant patient harm. The goal of our study is to describe the patient population and outcomes of BRT interactions at a large academic medical center.
Methods: We identified all patients admitted to UNC Hospitals from July 2016 through June 2017 for whom a BRT intervention was initiated. We collected demographic information, diagnosis codes, substance abuse history, and psychiatric history as well as reviewed narrative descriptions of events and outcomes as described in the electronic medical record.
Results: There were 271 BRs (~23 per month) during the 1-year study period and 1 injury each month occurred for both patients and hospital staff during BR episodes. Hospital staff were verbally threatened with physical harm ~41% of the time and some form of patient restraint (chemical or mechanical) was used in ~2 of every 3 cases (Table 1). In multivariate analysis, age ≥ 65 years (p=0.036) and patient threatening harm to staff (p=0.003) were associated with increased likelihood of both physical and chemical restraints. Table 2 is a sample of chart narratives from BR episodes.
Conclusions: To our knowledge, this is the first study to describe patient demographics and outcomes during BR episodes at a large academic medical center. Our analyses show that older patients (≥ 65 years) are at increased risk of being restrained during BR episodes and ~1 patient and/or staff member is injured each month during BR episodes. Future studies should focus on reducing the need for patient restraints and interventions to reduce both patient and hospital staff harm.
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