2023 14th Annual NUBE Conference

Management of agitated patients is central to clinical practice in the emergency room (ER) and in psychiatry training is a core objective per Accreditation Council for Graduate Medical Education (ACGME) guidelines(1, 2). The potential for unmanaged agitation to escalate to aggressive behaviors can harm patients, staff, and others, which makes it imperative to address quickly and efficiently (1). Rapid, systematic, and standardized implementation of de-escalation strategies, and behavioral interventions reduces the need for calming medications and physical restraints, which are associated with various adverse outcomes(3).The Best Practices in Evaluation and Treatment of Agitation (BETA) project guidelines are currently the standard of care and detail methods for a non-coercive, patient-centered, and collaborative approach to managing acutely agitated patients. They are nationally adopted in numerous psychiatric clinical centers across the US (4). Many institutions also now utilize highly-trained and dedicated intervention teams who are paged instantly when there is an agitated patient. This strategy, “Code White”, is currently implemented at Maimonides Health, a community hospital and academic training center in Brooklyn, NY. Code White is a departmental alert in the ER to mobilize a multidisciplinary team of staff, led primarily by psychiatry residents and attendings. It is activated in order to safely care for all patients with acute agitation. The hospital-specific Code White protocol was first designed and implemented in 2019 and has drawn heavily from BETA project guidelines (5). The design was informed by frontline clinical staff identifying key obstacles to the management of agitation. The protocol has evolved significantly in response to staff and patient feedback and has been integrated at various levels into resident didactics and staff training. We have developed a multi-level strategy to equip residency training programs in community hospital settings with the information and tools required to integrate effective agitation management into resident didactics and staff training. Our workshop is designed for psychiatry and emergency medicine residents, attendings, program directors, and psychologists. We aim to share our efforts towards the development of an effective resident didactic curriculum on agitation, the creation of inter and intra-departmental Code White simulation trainings, and the formation of an agitation management task force. The trainings and task force interventions are designed for all staff, including nurses, mental health workers, social workers, and psychologists, as well as physicians. We have administered our training in various clinical and academic settings with good responses. Through this workshop, we aim to highlight the importance of translating national and local policies and guidelines on agitation management into practical teaching and training sessions for residents and other staff and hope to share our experiences of this endeavor at a community hospital.

Learning Objectives:

1. Understand the challenges of managing agitation in a community hospital setting.
2. Understand the role of designing didactics and staff trainings to support evidence-based agitation management protocols.
3. Reflect on the practical stages involved in creating an iterative process for translating improvements in protocols or policies for agitation management into staff training,