Therapeutic Intervention: An Initiative to Improve Early Recognition and Response to Patients in Escalating Behavioral Crises

Abstract

Direct care clinical staff on non-mental health units are at risk of abuse, harassment, assault, and disruptive behavior when caring for medical patients with mental or behavioral issues. Early recognition of escalating behaviors and the ability to de-escalate can reduce aggressive and threatening situations. Often, medical staff members are not trained to manage behavioral crises. Staff are uncertain of available resources and the correct activation levels for behavioral response teams. The lack of knowledge, skill, and experience has led to inundated activations and the overutilization of resource teams. This project aimed to implement an educational initiative to increase staff knowledge and skill, decrease activations, maintain patient safety, decrease staff injuries, and manage resources related to therapeutic interventions and behavioral emergencies. The Plan, Do, Study, Act (PDSA) continuous quality improvement process was implemented at a 970-bed, private, not-for-profit medical center. Established goals were achieved by utilizing key members of the behavioral response team in educating clinical staff through real-time training, disseminating tip sheets and pocket handouts, and reinforcing organizational policy. Qualitative and quantitative results support the initiative’s significance as clinical staff felt more confident in recognizing and caring for patients demonstrating escalating behaviors. Response activations trended down. Staff injuries remained stable and were rarely associated with crisis interventions. The efficient use of organizational resources promoted comprehensive care and effective cost management that supports safe practices, scalability, and sustainability.