Simulation With Standardized Patients for Team-Based De-Escalation Training for Management of Agitation in Psychiatric Emergency: Description and Preliminary Findings

Friday, November 11, 2022

11:00 AM – 12:30 PM

Location: Room 217

Presenting Author(s)

Hochang Lee, MD, FACLP (he/him/his)

John Romano Professor and Chair
University of Rochester Medical Center
Rochester, New York

Co-Author(s)

WC

Wendi Cross, PhD

Professor of Psychiatry
University of Rochester Medical Center
Rochester, New York
Courtney Blackwood, MS RN

Director of Nursing in Psychiatry
University of Rochester Medical Center
Rochester, New York
HO

Heather O'Brien, MS RN NPD-BC

Senior Nurse Educator in Psychiatry
University of Rochester Medical Center
Rochester, New York
NB

Nancy Bowllan, EdD MSN RN

Nurse Educator in Psychiatry
University of Rochester Medical Center
Rochester, New York
PW

Patrick Walsh, PhD

Data and Project Manager
University of Rochester Medical Center
Fairport, New York

Abstract: Background/Significance: Psychiatric emergency settings are stressful clinical environments with multidisciplinary teams that address mental health crises with little continuing education. Simulation with Standardized Patients (SP) is an active learning method with the potential for hands-on practice and team skill development (Lateef, 2010). We developed and tested team-based de-escalation training to reduce restraint and seclusion of aggressive individuals at a Comprehensive Psychiatric Emergency Program (CPEP) at University of Rochester Medical Center.

Methods: This training program consisted asynchronous online didactics, team-based simulations with SP and standardized feedback, and an extended debrief process. 36 team simulations were conducted in a simulated emergency psychiatry setting, monitored by trainers with cameras and microphones. Three scenarios (2 male, 1 female) focused on agitated patients at risk for violence. SPs provided feedback immediately after simulations, before debrief. Data collection occurred at pre (Demographics, Confidence in Coping with Patient Aggression Instrument [CCPAI, Thackrey, 1987] TeamSTEPPS® Teamwork Perceptions Questionnaire [T-TPQ, Battles, 2010]), immediate post (CCPAI, Simulation Experience), and 3-month follow-up (CCPAI, T-TPQ, 4 items).

Results: Overall, 160 faculty and staff members participated in the training and assessments; 143 completed both pre and post assessments; 72 completed assessments at all 3 timepoints. The Simulation Experience was highly rated: participants agreed/strongly agreed the simulation was realistic (77%), the feedback was helpful (82%), they were more confident working with the team in a crisis (79%) and using de-escalation techniques (72%). There was significant improvement in CCPAI total scores from pre to post simulation; (paired t-tests) pre-post t(141) = 9.28, p </em>< .01, moderate-large effect size (.78); that was sustained at 3-months; post-follow-up t(71) = 0.60, p = .55. There was no significant change reported pre to follow-up on T-TPQ total scores. At 3-month follow-up: 42% of respondents reported they noticed improvement in team communication since the simulation training; 64% would recommend the training to other staff, 57% would repeat the training annually on a voluntary basis.

Discussion: Team training using simulation with SP was highly valued by CPEP staff, especially those who are younger and new to their positions; a significant positive impact on confidence working with aggressive patients was sustained over time. Multidisciplinary partnership in developing and implementing the training program was highly valued for team-building among all participants.

Conclusion/Implications: Training that includes actual practice through simulation can enhance staff communication and skills working with aggressive patients at risk for restraint and seclusion.

References:
1. Lateef, F. (2010). Simulation-based learning: Just like the real thing. J Emerg Trauma Shock, 3(4), 348–352.
2. Thackrey, M. (1987). Clinician confidence in coping with patient aggression: assessment and enhancement. Prof Psychol Res Pract, 18(1):57-60.
3. Battles, J., & King, H. (2010) TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) Manual.