Behavioral Intervention Team to Reduce High-Risk Behaviors in the Acute Care Setting: A Quality Initiative

OBJECTIVES: Medically ill patients, especially those with psychiatric comorbidities, may exhibit behavioral disturbance while hospitalized. Restlessness, removing medical devices, or wandering may lead to sentinel events such as falls, elopements, or violence. An interdisciplinary behavioral intervention team (BIT) was implemented to address and anticipate the need for behavioral health support on medical units. A retrospective review was conducted to evaluate the effects of BIT interventions on patient safety events. METHODS: Two psychiatric nurses were embedded on medical/surgical units as part of medical and psychiatric interdisciplinary teams. A retrospective review was conducted to evaluate outcomes. Two time periods were examined: 6 months with early-BIT efforts and 6 months with expanded-BIT efforts. Medical records and safety reports were reviewed, and statistical analysis was conducted in SAS Enterprise Guide 8.3. Statistical significance was based on associated P-values (P<0.05). RESULTS: Of admitted patients during the study period (N=1413), pre-existing psychiatric diagnoses were present in 58% of cases, with mood, anxiety, and neurocognitive disorders being most common. A majority of patients were on psychotropic medications during both study periods; however, there was a significant decrease in the use of psychotropic medications with expanded-BIT efforts (71.2% versus 61.3%, P<0.001). In comparing early-BIT efforts to expanded-BIT efforts, significant reductions in workplace aggression (6.7% versus 2.3%, P<0.001), use of restraints (5.8% versus 3.4%, P=0.034), and need for security officers (4.2% versus 0.8%, P<0.001) were observed. CONCLUSIONS: Engaging BIT significantly reduced aggression, restraint use, and security officer interventions. An interdisciplinary BIT is feasible and effective in reducing negative outcomes.