BACKGROUND Pediatric patients with behavioral needs are frequently admitted to the hospital for medical care; when behavioral crises occur, patients and staff are at risk for injury. Our aim was to implement a behavior response team (BRT) to increase the days between employee injury due to aggressive patient interactions on the inpatient medical units from 99 to 150 over 1 year. METHODS A multidisciplinary team used quality improvement methods to design and implement the BRT system that includes 2 options: huddle to proactively plan for patients exhibiting early signs of escalation and STAT for immediate help for patients with imminent risk of harm to self or others. Using run and statistical process control charts, we tracked events per month, days between Occupational Safety & Health Administration-recordable events, and violent restraint use over time for 1 year after implementation. Staff pre and postimplementation surveys were compared to assess staff perception of safety and support provided by the BRT intervention. RESULTS The BRT was implemented across the inpatient system in July 2020, with an average number of 13 events per month. Days between Occupational Safety & Health Administration-recordable events remained stable with a maximum of 134 days. Restraint use remained stable at 0.74 per 1000 patient days. The perception of behavioral support available to staff increased significantly pre to postsurvey. CONCLUSIONS The implementation of a BRT can improve staff perception of support and confidence in safely caring for patients with behavior needs on the inpatient medical unit, although additional provider- and system-level improvements are needed to prevent employee injuries.

中文翻译：

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儿童医院紧急护理行为响应小组的实施。

背景 有行为需求的儿科患者经常被送往医院接受医疗护理；当行为危机发生时，患者和工作人员面临受伤的风险。我们的目标是建立一个行为响应团队 (BRT)，在一年内将员工因住院医疗单位的积极患者互动而受伤的间隔时间从 99 天增加到 150 天。方法 一个多学科团队使用质量改进方法来设计和实施 BRT 系统，其中包括 2 个选项：针对出现早期升级迹象的患者采取紧急计划，以及针对即将面临自我或他人伤害风险的患者采取 STAT 立即帮助措施。使用运行和统计过程控制图，我们跟踪了实施后一年内每月的事件、职业安全与健康管理局可记录事件之间的天数以及暴力约束的使用情况。对实施前和实施后的工作人员调查进行比较，以评估工作人员对 BRT 干预措施所提供的安全和支持的看法。结果 2020 年 7 月，BRT 在整个住院系统实施，平均每月发生 13 起事件。职业安全与健康管理局可记录事件之间的天数保持稳定，最长为 134 天。约束使用率稳定在每 1000 个患者日 0.74 次。调查前，员工对行为支持的看法显着增加。结论 尽管需要在提供者和系统层面进行额外的改进以防止员工受伤，但 BRT 的实施可以提高员工对住院医疗单位安全护理有行为需求的患者的支持感和信心。