(143) A QI Project: Transforming Management of Agitation in the Medically Hospitalized Patient Through Resident Education

Abstract:

Background: Agitation is a common behavioral syndrome observed in hospitalized patients which poses challenges to healthcare providers on the medical floors (Haskell, 1997). There are a variety of conditions that cause agitation, highlighting the need for timely identification. Given this diagnostic complexity, agitation is often managed with psychotropic medications and/or restraints (Richmond, 2012). This provides an opportunity to enhance education on assessment and management of agitation. The purpose of this project is to improve the quality of care of medically ill patients compromised with agitation.

Methods: A survey will be administered to Internal Medicine (IM) residents to assess their comfort in preventing, assessing, and managing agitation. We will implement a lecture series aimed at educating residents directed in those areas. Following the educational series, a survey will be administered to evaluate improvement in residents’ responses.

Results: At the time of abstract submission, there is no data to report.

Discussion: While there is an abundance of literature on the management of agitation, there appears to be dissonance between theory and practice as pressures to resolve difficult situations often drive clinicians to more directive measures (Martínez-Raga, 2018). As such, the overarching message appears to be lost in translation as theory doesn’t always meet practice (Roppolo, 2020). The CL psychiatrist is in a unique position primed to reintroduce, redeliver and reinforce best practices in managing hospital agitation. The CL service has the ability to redemonstrate its value in liaison work by inspiring transformation through education.

Conclusion/Implications:

Our hope is that this educational outreach program geared towards IM residents will instill confidence in their ability to prevent, diagnose and resolve agitation in the least invasive manner. We envision this series being incorporated into residency curriculum for IM residents, thereby improving patient care and limiting use of pharmacological interventions and restraints.

References

Haskell, R. M., et al. AACN clinical issues 1997; 8(3), 335–350.

Martínez-Raga, et al. 1st International Experts' Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation. Frontiers in psychiatry 2018; 9, 54.

Richmond, J. S., et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. The western journal of emergency medicine 2012; 13(1), 17–25.

Roppolo, L. P., et al. Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation). Journal of the American College of Emergency Physicians open 2020; 1(5), 898–907.

Presenting Author(s)

Meghan Oswald, DMD, MD

Psychiatry Resident
Zucker School of Medicine/Northwell Health at Mather Hospital
Blue Point, NY, United States

Co-Author(s)

Nida Khan, DO

Resident Physician
John T. Mather Hospital/Northwell Health
Port Jefferson, New York, United States
John Lotfi, MD, JD

Psychiatry Resident
Zucker School of Medicine at Hofstra/Northwell Health at Mather Hospital
Port Jefferson, NY, United States
SK

Saad Khan, DO

Director of CL Psychiatry at Mather Hospital Northwell Health
Zucker School of Medicine at Hofstra/Northwell Health at Mather Hospital
Port Jefferson, New York, United States