The purpose of the proposed study is to evaluate the impact of a behavioral intervention team (BIT) on 2 adult units: a general medical (8N); a cardiac/medical stepdown (8S) at Vanderbilt University Medical Center (VUMC) with a higher proportion of patients with behavioral health comorbidities.
The BIT will provide a proactive psychiatric team that will screen all patients on admission, provide consultation to those meeting established criteria, and recommend interventions to the primary care team for consideration. BIT will also serve to model therapeutics tactics in communication and goal setting to the clinical staff. Research Questions for the proposed study: Considering that behavioral health co-morbidity is common among hospitalized medical inpatients and is associated with higher costs of care and staff dissatisfaction, we will ascertain whether the addition of dedicated, trained behavioral intervention team, compared to nursing staff training on trauma informed care and de-escalation techniques provides: 1. meaningful, measureable improvement in the prevention and management of disruptive behavior in the healthcare setting at VUMC, and 2. Improvement in staff perceptions of their ability to manage patients exhibiting disruptive, threatening or acting out behavior Specifically, using a pragmatic, cluster cross-over trial design where the BIT crosses between 8N and 8S, we will test the hypothesis that presence of the BIT results in: 1. Improvement in the prevention and management of patients exhibiting disruptive, threatening or acting out behavior 2. Improvement in staff perceptions of their ability to manage patients exhibiting disruptive, threatening or acting out behavior
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
3,800
Multidisciplinary team to assist with actively identifying and managing mental illness and substance abuse disorders at their earliest possible time during hospitalization.
Participants in this group will receive standard of care.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Percent of violence control measures utilized
By extracting medications, restraints, and sitters ordered from the electronic health records
Time frame: 6 months
Percent of patient injurious behaviors reported
By extracting reports of biting, kicking, throwing, etc. from the electronic medical record
Time frame: 6 months
Percent change in nurse comfort and confidence in their ability to manage patients exhibiting disruptive, threatening or acting out behavior
By administering surveys to participants
Time frame: 1 year
Rate of unit nursing staff retention
By extracting rates from internal human resources records
Time frame: 1 year
Patient length of stay
By extracting data from the electronic health record
Time frame: 6 months
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