Reducing physical assaults on residents through implementation of project BETA: Best practices in the evaluation and treatment of agitation

We created a multitude of initiatives that were in line with the principles of the BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines to determine if these initiatives would reduce the physical assault rate by patients on emergency medicine (EM) residents.

We conducted three cross-sectional surveys of our EM residents (PGY-1 to -3) to determine the incidence of physical assaults by agitated patients at a large county hospital emergency department. These were primarily anonymous REDCap surveys and were administered at the following intervals: (1) pre-BETA initiative implementation, (2) approximately 12 months after implementation, and (3) 5 years postimplementation. Unfortunately, the in-person deescalation, self-defense, and simulation training were canceled 2 years prior to the last survey due to COVID-19. The second survey only looked at the incidence of physical assaults during the prior 6 months whereas the other two surveys evaluated the incidence of physical assaults since starting residency.

The survey response rates for the three REDCap surveys were 76% (50/66), 80% (53/66), and 71% (49/69), respectively. The percentage of EM residents who were physically assaulted per survey period were as follows: preimplementation cumulative assaults 28% (14/50), 12 months after implementation for 1 full academic year 11.3% (6/53), and postimplementation cumulative assaults during residency 5 years later 30.6% (15/49). The two independent-samples proportions tests comparing the number of physical assaults before and approximately 12 months after all of these initiatives were implemented was significant (p = 0.032).

An education and training curriculum designed to improve EM residents' ability to manage agitated patients may reduce the incidence of physical assaults on them by patients in their care. However, the decrease in physical assaults after these initiatives followed by the increase in physical assaults experienced after the COVID-19 pandemic are most likely multifactorial.