Who You Gonna Call? Outcomes of a Team-Based Approach to Respond to Disruptive Behavioral Issues in Hospitalized...

The behavioral response system (BRS) at one institution is designed to bring immediate resources to bear when hospitalized patients experience acute episodes of disruptive behavior. The goal of this study was to describe the patient population, inciting events, and outcomes of the BRS.

The researchers identified all patients admitted to the institution from July 2016 to June 2017 for whom the BRS was activated. Descriptive statistics were calculated, and logistic regression was used to evaluate associations between demographic and clinical characteristics and use of physical and/or chemical restraints.

There were 271 BRS calls (range: 0-9 per day). One injury every month occurred for patients and hospital staff. Men, African Americans, and older patients were significantly overrepresented in BRS calls when compared to the overall hospital population. Either chemical or physical restraints were used in 68.7% of cases: 53.9% of patients (or visitors) received chemical restraints, 28.8% were placed in physical restraints, and 17.7% were placed in manual holds. In multivariate analyses, use of physical and chemical restraints were correlated with age ≥ 65 years. Having a dementia/delirium diagnosis was the only significant predictor of chemical restraints, and threatening harm to staff or self was a significant predictor of the use of physical restraints.

Our study adds to the growing body of knowledge describing how BRSs interact with patients and hospital staff at large academic medical centers. Future studies should focus on investigating if implicit bias influences provider activation of the BRS and reducing the need for patient restraints.