O1002: Designing a Pediatric Behavioral Response Team Through Simulation and Failure Mode & Effects Analysis

Purpose/Objectives: With the surge of pediatric hospitalizations for behavioral health conditions since the onset of the COVID-19 pandemic, workplace violence related to patient aggression has become more common. In fiscal year 2021, employees at our tertiary children’s hospital experienced an increase in employee injuries related to aggressive patient behavior. A behavioral response team (BRT) STAT is a structured process that brings trained personnel immediately to the bedside of an agitated patient to engage in de-escalation. At hospitals that serve adult patients, BRT implementation has reduced restraint use and staff injuries, while improving staff knowledge and self-efficacy. However, BRTs have not been widely implemented at children’s hospitals. Our objective was to design a BRT STAT to provide a streamlined, hospital-wide response to episodes of pediatric acute agitation.

Design/Methods: We convened a BRT Design Team consisting of 17 multidisciplinary stakeholders, including representation from the emergency department, hospitalists, inpatient nursing, nursing assistants, psychiatry, security, pharmacy, pediatric residents, quality and safety, patient and family services, and clinical and organizational development. Over 6 months, the team worked collaboratively to design a BRT STAT process, which was piloted and refined using in-situ simulations and comprehensive failure mode and effects analysis (FMEA). FMEA was used to assign risk, prioritize, and categorize potential failures of the BRT process identified during simulations.

Results: The BRT Design Team achieved consensus on BRT STAT initiation criteria, roles and script (Figure 1), and debriefing tools. To identify process vulnerabilities, in-situ simulations were conducted in 4 hospital areas including 2 medical floors, the intensive care unit, and the emergency department, involving 30 participants. Across 19 steps of the BRT STAT response, FMEA resulted in identification of 79 potential failure modes, and 16 failure modes were prioritized to be addressed by stakeholders before hospital-wide BRT STAT implementation. Completed action items included adding medications for acute agitation management to medication dispensing machines on each floor, revising an agitation algorithm for medication use, creating an educational module about the BRT STAT response, and placing behavioral health carts on each unit (Figure 3) to house behavioral personal protective equipment, restraints, and resources related to behavioral health care.

Conclusion/Discussion: This design process resulted in development of a BRT STAT response that promotes patient and employee safety during episodes of patient agitation or aggression at a children’s hospital. Future directions will include assessing restraint use and staff injuries over time, following hospital-wide implementation.