Implementing a Behavioral Escalation Response Team to Promote Patient and Staff Safety: A Descriptive Qualitative Study

OBJECTIVES: In hospital settings, Code White emergencies are initiated in response to behavioral escalations, which pose significant safety risks to staff and patients. While clinical staff typically receive support in managing behavioral escalations during Code White emergencies, which oftentimes triggers a security-led response, the Behavioral Emergency Response Team (BERT) offers a proactive alternative. BERT was implemented across 2 hospitals within a unified health care network in Toronto. The aim of this study was to explore clinical staff perspectives on the BERT model, with particular attention to identifying perceived strengths and areas for improvement. METHODS: This study used a qualitative descriptive design, and semi-structured interviews were conducted with 14 staff members who had accessed BERT services, including nurses, social workers, clinical educators, and clinical managers. RESULTS: Analysis revealed 4 themes: (1) enhancing care with proactive behavioral management; (2) cultivating a culture of safety through collaborative practices; (3) promoting patient-centered care in behavioral management through capacity building; (4) supporting future clinical practice. The findings of this study highlight the value of BERT in supporting clinical staff to manage behavioral escalations through a proactive and collaborative approach, which contributed to staff confidence and a perceived sense of safety and support when managing responsive or escalating behaviors. CONCLUSION: The BERT model represents a proactive, collaborative, and effective approach to managing behavioral escalations in health care settings. By shifting the focus from reactive security responses to early, clinically led intervention, BERT enhances safety for patients and staff while supporting a culture grounded in trauma-informed, least-restraint care.