Study objective

Agitation, defined as excessive psychomotor activity leading to violent and aggressive behavior, is becoming more prevalent in the emergency department (ED) amidst a strained behavioral health system. Team-based interventions have demonstrated promise in promoting de-escalation, with the hope of minimizing the need for invasive techniques, like physical restraints. This study aimed to evaluate an interprofessional code response team intervention to manage agitation in the ED with the goal of decreasing physical restraint use.

Methods

This quality improvement study occurred over 3 phases, representing stepwise rollout of the intervention: (1) preimplementation (phase I) to establish baseline outcome rates; (2) design and administrative support (phase II) to conduct training and protocol design; and (3) implementation (phase III) of the code response team. An interrupted time-series analysis was used to compare trends between phases to evaluate the primary outcome of physical restraint orders occurring during the study period.

Results

Within the 634,578 ED visits over a 5-year period, restraint use significantly declined sequentially over the 3 phases (1.1%, 0.9%, and 0.8%, absolute change −0.3% between phases I and III, 95% confidence interval [CI] −0.4% to 0.3%), which corresponded to a 27.3% proportionate decrease in restraint rates between phases I and III. For the interrupted time-series analysis, there was a significantly decreasing slope in biweekly restraints in phase II compared to phase I (slope, −0.05 restraints per 1,000 ED visits per 2-week period, 95% CI −0.07 to −0.03), which was sustained in an incremental fashion in phase III (slope, −0.05, 95% CI −0.07 to −0.02).

Conclusion

With the implementation of a structured agitation code response team intervention combined with design and administrative support, a decreased rate of physical restraint use occurred over a 5-year period. Results suggest that investment in organizational change, along with interprofessional collaboration during the management of agitated patients in the ED, can lead to sustained reductions in the use of an invasive and potentially harmful measure on patients.

中文翻译：

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急诊科煽动代码响应小组的设计与实现

学习目标

躁动被定义为导致暴力和攻击行为的过度精神运动活动，在紧张的行为健康系统中，急诊科 (ED) 变得越来越普遍。基于团队的干预措施已显示出促进降级的希望，希望最大限度地减少对侵入性技术（如身体约束）的需求。本研究旨在评估跨专业代码响应团队干预，以管理急诊中的躁动，以减少身体约束的使用。

方法

这项质量改进研究分 3 个阶段进行，代表干预措施的逐步推出：(1) 实施前（第一阶段）确定基线结果率；(2) 进行培训和方案设计的设计和行政支持（第二阶段）；(3) 代码响应团队的实施（第三阶段）。中断时间序列分析用于比较阶段之间的趋势，以评估研究期间发生的身体约束命令的主要结果。

结果

在 5 年期间的 634,578 次急诊就诊中，约束使用在 3 个阶段依次显着下降（1.1%、0.9% 和 0.8%，第一阶段和第三阶段之间的绝对变化 -0.3%，95% 置信区间 [CI] -0.4% 至 0.3%），这对应于第一阶段和第三阶段之间约束率按比例下降 27.3%。对于中断的时间序列分析，与第一阶段相比，第二阶段的双周限制斜率显着降低（斜率，每两周每 1,000 次急诊就诊 -0.05 次限制，95% CI -0.07 至 -0.03），这在 III 期以增量方式持续（斜率，-0.05，95% CI -0.07 至 -0.02）。

结论

随着结构化的煽动代码响应团队干预与设计和行政支持相结合的实施，在 5 年的时间里，身体约束的使用率有所下降。结果表明，对组织变革的投资，以及在急诊室管理激越患者期间的跨专业合作，可以持续减少对患者使用侵入性和潜在有害措施的情况。