2023 14th Annual NUBE Conference

Background: Agitation and behavioral related emergencies stemming from psychosis, delirium, substance use, or psychological trauma are common in emergency departments (EDs), and frequently place patients and staff at risk of violence, abuse, and traumatization.1 Similar to how a Rapid Response Team responds to patients in medical crises, a Behavioral Emergency Response Team (BERT) is a multidisciplinary group of healthcare professionals with psychiatric and behavioral healthcare experience who respond to patients in behavioral crises to prevent harm.2 Research published from BERT programs show significant decrease in assaults, security involvement, and restraint use on patients.3,4,5,6 The purpose of this work is to demonstrate a framework and research protocol for the development of a BERT program at a safety-net hospital while fostering an understanding about the efficacy of BERT programs and their need for violence prevention in EDs. Methods: A multidisciplinary team at Highland Hospital in Oakland, CA, led by emergency medicine physicians, in collaboration with hospital administration, nursing, and security have created a framework for a BERT consultant program. In this framework, BERT can be activated emergently in the ED as a “Code BERT” for behavioral emergencies to provide immediate de-escalation. “Code BERT” may prevent the activation of a “Code Grey” in the hospital, which is an established rapid response led by security and law enforcement. BERT can also be consulted non-emergently for patients, including patients on a psychiatric hold, to develop individualized plans to prevent behavioral escalation. Similar to BERT programs at other hospitals, our program will be staffed by nurses, social workers, and psychiatric technologists. Medical providers may easily consult with BERT and review BERT encounters via our electronic medical record (EMR). Evaluation of program efficacy will include structured interviews with patients and staff as well as data extracted from the EMR. Results: Program efficacy will be based on quantitative and qualitative data. Qualitative data will include patient and staff interviews on perceived safety and satisfaction prior to and six months after implementation of BERT. Quantitative data will focus on metrics including number of BERT consults, comparison of number of Code BERTs vs Code Greys, and use of chemical and physical restraints on patients. These metrics will be used to assess utilization of the BERT team, security and law enforcement services, and patient restraints. Conclusions: BERT programs increase patient and staff safety, improve staff satisfaction, and decrease behavioral related emergencies while promoting a culture of patient-centered care. In this work, we show the development of a BERT program at our safety-net, county hospital initiated by emergency medicine residents and attendings. We hope our framework and research methods may be helpful to other programs and look forward to discussing and collaborating on best practices for violence prevention in behavioral emergencies.

Learning Objectives:

1. Learn about the impact of BERT programs that have been established at various institutions.
2. Design a workflow for BERT policies and procedures and research methods to evaluate program efficacy.
3. Identify key stakeholders and assemble an interdisciplinary team.