Behavioral Emergencies in the General Hospital: Role of C-L Psychiatry in Early Management and Prevention

Background: Within the general hospital setting, Consultation-Liaison (C-L) Psychiatry services are critical for managing patients with behaviors that frequently result in behavioral emergencies, including agitation, verbal aggression, physical aggression, and demanding behavior (Pestka et al., 2012). To most effectively manage these difficult patient behaviors, early consultation to C-L Psychiatry may prevent behavior from escalating to the level of a behavioral emergency. Yet, data is limited regarding the effectiveness of C-L Psychiatry in impacting the occurrence and reoccurrence of behavioral emergencies.

Method: Data on all behavioral emergencies that occurred at the University of Virginia Medical Center from January 2020 to December 2020 were collected. Variables collected include patient demographic information, frequency of behavioral emergency, type of behavioral emergency, factors contributing to behavioral emergency, and whether the C-L Psychiatry service had been consulted. Patients who received a C-L Psychiatry consult prior to a behavioral emergency will be compared on the above variables to patients who did not receive this consult to identify differences between the two groups.

Results: Preliminary data indicates that UVA Medical Center had an average of 61.2 (range 38-82) behavioral emergencies per month between January 2020 and December 2020. These fell into five categories consistent with previous pilot data: physical aggression, leaving the unit, verbal aggression, agitation, and non-compliance (Yost & Smith, 2020). Factors contributing to behavioral emergencies were identified as delirium, dementia, personality disorder, substance withdrawal, frustration, and TBI. Data will be further analyzed to determine how frequently patients who exhibit behavioral emergencies had received C-L Psychiatry services prior to the behavioral emergency or had not received this service during their hospitalization. Additional analyses will be conducted to determine differences between these two groups on type of behavioral emergency and factors contributing to behavioral emergency.

Discussion: This data will inform how patients with challenging behavior are identified early in their hospitalization and how C-L Psychiatry can proactively intervene to decrease behavioral emergencies. Further, this project suggests a need to create process for identifying patients at risk for behavioral emergencies. Future directions will be discussed.

Conclusions/Implications: The findings from this quality improvement project have important clinical implications concerning how C-L Psychiatry manages patients with challenging behavior and how frontline staff identify and utilize C-L Psychiatry.

References:

Pestka EL, Hatteberg DA, Larson LA, Zwygart AM, Cox DL, Borgen EE Jr. Enhancing safety in behavioral emergency situations. Medsurg Nurs. 2012; 21(6):335-41.

Yost, JS & Smith, JB. A taxonomy of behavioral emergencies in the general hospital: A comparison of behavioral emergencies pre-covid-19 and during the covid-19 outbreak. Brief oral presentation delivered at the 2020 Annual Meeting of the Academy of Consultation-Liaison Psychiatry.