DART Reduced: Quality Improvement and Patient Safety Methods Applied to Protect Staff from Pediatric Patient Aggression and Violence

Protecting staff from injuries due to patient aggression is an important activity of a healthcare system and this presentation details the efforts of a multidisciplinary approach that utilizes quality improvement and patient safety methods to reduce those harms in the pediatric med-surg setting. With new regulatory attention to this topic, our hospital system sought to focus on those injuries that led staff to need to take time away, restricted, or transferred from typical work (the "DART" rate): we sought to reduce the DART due to patient behaviors by more than 25%. Unlike experience in inpatient psychiatric units, there is minimal literature on aggression by pediatric patients in medical/surgical settings.



Our presentation first provides data on the nature of the severe injuries endured by staff, including the types of injuries and characteristics of patients who effect such harms. The presentation then will describe the inter-disciplinary approach to these problems that followed typical quality improvement and patient safety methodology. This focused on 4 areas: the environment and equipment, training for staff, direct patient care, and the operations and communications involved in working with injured staff. The specific risks inherent in these topic will be reviewed and interventions made will be discussed including kevlar sleeve protective equipment, de-escalation techniques, basic universal methods to prevent injury, and the creation of a peer-based intervention for injured staff. In this context there will be the opportunity to discuss these interventions and their relationship to a reduction in the DART that exceeded our goals.



In this context the presentation will provide information about the types of aggression and violence endured by staff in the pediatric hospital and about methods to protect the safety and health of those who care for these populations.