Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety.

BACKGROUND: Unexpected situations of workplace violence are occurring in the United States at increasing rates in health care environments, warranting increased attention to processes supporting safety for health care workers. At a large, academic hospital, two patient safety incidents had occurred in a two-year period in which a patient had become violent at the time of admission from the emergency department (ED) to the medical unit. METHODS: A multidisciplinary quality improvement (QI) team was formed to address the risk of violent patient events. Using two iterative Plan-Do-Study-Act (PDSA) cycles, the QI team designed and tested a huddle handoff communication tool, the Potentially Aggressive/Violent Huddle Form. An ED nurse would initiate the huddle process by informing the admitting unit that a patient at risk for violence was being admitted. The admitting care team would then call the ED team so that both teams participated in the handoff call together. The huddle process occurred for 21 transfers in the first PDSA cycle and for 18 transfers in the second. RESULTS: RNs from the ED and the six medical units reported feeling safe during the transfer process 100% of the time during both tests of change PDSAs (vs. 54.7% at baseline). In the ED, from the first test of change to the second test of change, satisfaction with the process improved from 53.3% to 75.0%. CONCLUSION: The huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the health care workplace.

Enhancing safety in behavioral emergency situations.

The implementation of a behavioral emergency response team (BERT) at a large midwestern health care organization is described. The BERT is a resource supporting nurses and other health care staff in managing behavioral emergencies. The Joint Commission (2010) reported an increasing rate of violence by patients toward health care staff, reinforcing a need for the BERT. No published reports were found in the literature of a BERT utilizing multidisciplinary mental health experts and security officers as responders. Development strategies, response data, and outcomes of this successful initiative are highlighted.

In-room display of day and time patient is anticipated to leave hospital: a "discharge appointment".

BACKGROUND: We learned from a focus group that many patients find discharge to be one of the least satisfying elements of the hospital experience. Patients cited insufficient communication about the day and time of the impending discharge as a cause of dissatisfaction. OBJECTIVE: In partnership with the Institute for Healthcare Improvement, Improvement Action Network collaborative, we tested the practicality of an in-room "discharge appointment" (DA) display. SETTING AND PATIENTS: Eight inpatient care units in 2 hospitals at an academic medical center (Mayo Clinic, Rochester, MN). INTERVENTION: DA displayed on a specially designed bedside dry-erase board. MEASUREMENTS: The primary outcome was the proportion of discharged patients who had been given a DA, including same-day DAs. Secondary outcomes were (1) the proportion of DAs scheduled before the actual dismissal day and (2) the timeliness of the actual departure compared with the DA. RESULTS: During the 4-month period, 2046 patients were discharged. Of those, 1256 patients (61%) were given a posted DA, of which 576 (46%) were scheduled at least a day in advance and 752 (60%) departed from the care unit within 30 minutes of the appointed time. CONCLUSIONS: With a program for in-room display of a DA in various hospital units, more than half the patients had a DA set, and most of the DA patients departed on time. Further investigation is needed to determine the effect of DAs on patient and provider satisfaction.