In the fast-paced environment of a hospital, especially one dealing with patients who may be mentally distressed, the safety of both staff and patients is paramount. A recent incident at Penn Medicine Chester County Hospital illustrates the importance of mental health support in ensuring a safe environment for healthcare workers.
Incident Overview
In one case, a patient with dementia became confused and expressed a strong desire to leave the hospital, displaying verbal aggression towards the nursing staff. Recognizing the potential for escalation, the staff promptly called the newly formed Behavioral Response Team (BRT) for assistance. The team arrived quickly, with a mental health technician engaging the patient in a meaningful conversation about a topic they were passionate about. This approach successfully de-escalated the situation, allowing the patient to complete their treatment and safely discharge.
Such rapid interventions are critical in a hospital setting, where patients in psychological distress can exhibit aggressive behaviors. This incident underscores the necessity of the BRT, which was established to equip staff with the resources and support needed to manage potentially violent situations effectively.
The Behavioral Response Team: A New Initiative
The Behavioral Response Team at Chester County Hospital was initiated in July 2023 as part of a pilot program aimed at providing real-time, in-person responses to patients exhibiting signs of psychiatric distress or behavioral escalation. Recognizing the increasing need for such resources, hospital leadership commissioned an outside consultant to conduct a comprehensive behavioral health and workplace violence risk assessment. This assessment involved interviews with front-line staff and a thorough review of hospital policies and environments.
Kyle Finucane, MSW, director of Behavioral Health for the hospital, stated, “We wanted to focus on a proactive approach.” The BRT was developed to decrease incidents of violence and empower frontline staff by expanding their skills and confidence in managing patients with behavioral health needs.
Program Impact and Expansion
During its initial nine-month pilot, the BRT operated on three inpatient units from Monday to Friday, 8 a.m. to 4 p.m. The results were significant: a 70% decrease in patient agitation was observed following interventions by team members. Encouraged by these outcomes, hospital leaders have expanded the program to provide 24/7 coverage to all inpatient units starting April 2024.
Team Training and Operations
The BRT is comprised of 20 specialized members from the hospital’s Behavioral Health department, including social workers and mental health technicians. All responders undergo extensive training that includes verbal de-escalation techniques, physical self-defense skills, and familiarity with hospital resources that can aid patients, such as spiritual care and counseling services. Trainees also participate in simulations of various behavioral response scenarios, ensuring they are well-prepared for real-life situations.
Patrick Johnson, MSW, a behavioral health supervisor, emphasizes the critical role of early intervention in preventing escalated behavioral outbursts. “The Behavioral Response Team can act as that additional layer of support to help our treatment teams more effectively manage and care for our patients,” he stated.
When called to assist, a behavioral health social worker and a mental health technician respond within 15 minutes. Their interventions may include discussing coping skills with the patient, applying verbal de-escalation strategies, managing medication needs, and coordinating consultations with mental health counselors. Importantly, the team follows up with the unit four hours later to assess ongoing needs.
Rising Mental Health Needs and Community Support
The demand for mental health services has surged since the COVID-19 pandemic, with Chester County Hospital witnessing a 73% increase in community members seeking help for behavioral health crises. This rise is particularly pressing given the closure of two local hospitals, which has limited access to mental health resources for the community.
In addition to the BRT, the hospital’s Behavioral Health Department offers non-urgent consultation services for patients experiencing mental health complications during their hospital stay. The presence of Haven Behavioral Hospital of West Chester, which provides inpatient and 24/7 crisis walk-in services, further supports the hospital’s commitment to addressing these critical community needs.
Commitment to Safety and Collaboration
Since the launch of the BRT, staff have reported feeling more supported during challenging situations, fostering a collaborative work environment. Kimberly Joffe, CRNP, consult-liaison psychiatry lead, observed an increase in staff preparedness and comfort in dealing with de-escalation, thanks to the team’s support.
Nurses have also noted that patients appreciate feeling heard and having access to additional resources that enhance their care. Nicole Eastburn, RN, expressed, “The Behavioral Response Team is extremely supportive of both nurses and our patients alike.”
Conclusion
The establishment of the Behavioral Response Team at Chester County Hospital exemplifies a proactive approach to mental health and safety in healthcare settings. By providing timely support for staff and patients alike, the BRT is helping to create a safer and more effective hospital environment, ultimately leading to better patient outcomes and improved staff morale. As mental health needs continue to rise, initiatives like the BRT are essential in ensuring that healthcare providers can navigate the complexities of patient care while maintaining their own safety and well-being.
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