Strategies for ED Psych Patients

Jacqueline Fellows, for HealthLeaders Media , May 13, 2014
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BERT is a three-person team that is paged when a psychiatric patient begins to show verbal signs of anxiety.

"It has to do with vocal tones, pacing, shifting about, being more demanding," says Lawrence Kuhn, MD, medical director for behavioral health at SSM. "These are early signs of anxiety and frustration. If you address patients at these early stages, you can usually find out what's going on and they will respond and let you know, and that's the key to this."

The BERT protocol began at SSM St. Mary's Health Center in Richmond Heights, Mo., a 525-bed hospital, in August 2012.

"Before BERT, everything had been done at the leadership level," says Sarah Lohse, RN, BSN, director of behavioral health services for SSM St. Mary's. "What's great about BERT is that it is owned by the employees and the staff. The people who respond are not leadership. They are the frontline experts."

Each BERT team includes a charge nurse, house supervisor, and security officer. Each person has a role, says Lohse. The charge nurse takes the lead, the house supervisor determines what resources are needed, and the security officer tries to build rapport.

"Security is stationed in our EDs so a lot of patients know security," says Lohse. "They're not necessarily there as a use of force; they're there as a use of support. If things do escalate and it becomes a security issue, then we have a security officer there."

Since implementing BERT, there has been a decrease in Code Strongs, the code that indicates a psychiatric patient's behavior has escalated and physical intervention is needed, often the use of restraints. Lohse calls the decrease one of the "biggest successes" of BERT.

"BERT is for when someone is verbal; we have a different code for when someone is physical," says Lohse. "The Code Strong was originally the only method we had for when someone was escalated. BERT has been added as an additional layer to encourage people to call earlier. We want to continue to see Code Strong declining and BERT increasing."

From August 2012 to September 2013, just a little over a year, 209 calls for help with a psychiatric patient in the ED have gone out at SSM St. Mary's; of those 172 were BERT and 37 were Code Strong.

Kuhn says there's been another benefit, too.

"Overall, I think it's made a difference in the way many of the people in the ED—as well as on the medical floors—see psychiatry," he says. "It's improved the way in which our staffs are talking with one another. I've been asked to go to a medical floor, if they have a problem patient, and do some consultative work with the staff as to how to manage them. I think it's improved the overall profile of psychiatry within the hospitals."

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This article appears in the May 2014 issue of HealthLeaders magazine.

Jacqueline Fellows is an editor for HealthLeaders Media.
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