Purpose: The purpose of this project was to implement a behavioral emergency response team (BERT) within ambulatory care (AC) to address aggressive or other behavioral health crises. BERT works to de-escalate situations and minimize patient, visitor, and employee exposure and prevent or mitigate workplace violence. As one of the top four key risks in AC, workplace violence is especially dangerous due to AC’s increased patient volume, isolation from resources, and minimal structured organizational support during aggressive events. Implementing BERT in AC became a priority due to its noted success in inpatient with efficacy at decreasing assaults by 90% and security responses by 93%. With the rise of workplace violence in healthcare as well as the organization’s increased episodes of verbal and aggressive behaviors from patients/visitors in AC, BERT was identified as a strategic goal and priority.
An interdisciplinary team of nurses, nurse leaders, and a Licensed Clinical Social Worker (LCSW) were tasked with implementing BERT in AC, with nurse leadership oversight. It was determined a BERT would augment nursing interventions during behavioral and aggressive events and a BERT response consisted of LCSW, Security, and AC leadership to ensure nursing and clinic support. Before implementation, policies and operational workflows were updated, staff educated, and an after-incident debriefing process created. Documentation and reporting were initiated to mirror the inpatient process to maintain system alignment while allowing for differences in practice settings.
Evaluation/Outcomes/Results: Prior to BERT, there were 108 security calls made by AC the previous year. Fees for security responses totaled $286,000, ranging from $150-$3500/hour, depending upon resources needed. As part of BERT, 2.4 FTE LCSWs were hired costing $257,000, a savings of nearly $30,000. After implementation, there were 80 BERT responses in the ten-month post-COVID window. LCSW responded to de-escalate difficult events in real time, either in-person or remotely. The type of response was determined by the distance to the AC site and the needed response time, the location of the LCSW, and the intensity of the situation. The LCSW worked with nurses, nurse leaders, and security to address events and assess the resources needed to de-escalate the situation. After BERT became more socialized across AC, nurses requested preventative BERT responses. Preventative BERTs were called prior to the arrival of a patient or visitor who had previously threatened or had a recent aggressive event in-person, on the phone, or in email. The BERT team arrived onsite before the patient appointment prepared to mitigate an escalation, de-escalate if needed, and promote safety for nurses and other patients. There were 42 preventative BERT visits in AC which proactively addressed workplace violence in addition to the 80 real-time BERT calls.
Conclusions/implications for practice: A BERT team response is a cost-effective and proactive approach to reducing workplace violence in AC. AC workplace violence events require dynamic resources to address behavioral and aggressive issues from patients/visitors and BERT provides a resource for AC’s unique practice environments.