Disruptive bEhavior manageMEnt ANd Prevention in Hospitalized Patients Using a behaviORal Intervention Team

Study Overview
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Brief Summary
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The purpose of the proposed study is to evaluate the impact of a behavioral intervention team (BIT) on 2 adult units: a general medical (8N); a cardiac/medical stepdown (8S) at Vanderbilt University Medical Center (VUMC) with a higher proportion of patients with behavioral health comorbidities.

Detailed Description
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The BIT will provide a proactive psychiatric team that will screen all patients on admission, provide consultation to those meeting established criteria, and recommend interventions to the primary care team for consideration. BIT will also serve to model therapeutics tactics in communication and goal setting to the clinical staff. Research Questions for the proposed study: Considering that behavioral health co-morbidity is common among hospitalized medical inpatients and is associated with higher costs of care and staff dissatisfaction, we will ascertain whether the addition of dedicated, trained behavioral intervention team, compared to nursing staff training on trauma informed care and de-escalation techniques provides: meaningful, measureable improvement in the prevention and management of disruptive behavior in the healthcare setting at VUMC, and Improvement in staff perceptions of their ability to manage patients exhibiting disruptive, threatening or acting out behavior Specifically, using a pragmatic, cluster cross-over trial design where the BIT crosses between 8N and 8S, we will test the hypothesis that presence of the BIT results in: Improvement in the prevention and management of patients exhibiting disruptive, threatening or acting out behavior Improvement in staff perceptions of their ability to manage patients exhibiting disruptive, threatening or acting out behavior

Official Title
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Disruptive bEhavior manageMEnt ANd Prevention in Hospitalized Patients Using a behaviORal Intervention Team: Study Protocol for a Pragmatic, Cluster, Cross-over Design

Conditions
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Behavioral Problem

Intervention / Treatment
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* Behavioral: Behavioral Intervention Team
* Behavioral: Standard of care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted to two adult medical surgical units (8N/8S) at Vanderbilt University Medical Center during the study period. All clinical nurses and staff on 8N/8S employed during the study period. Exclusion Criteria: Patients admitted to the floor before the BIT team has begun the crossover period on the unit.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Behavioral Intervention Team<br>The participants in this arm will receive the Behavioral Intervention Team. | Behavioral: Behavioral Intervention Team<br>* Multidisciplinary team to assist with actively identifying and managing mental illness and substance abuse disorders at their earliest possible time during hospitalization.<br>|
| Active Comparator: Standard of Care<br>The participants in this arm will receive the standard of care. | Behavioral: Standard of care<br>* Participants in this group will receive standard of care.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of violence control measures utilized | By extracting medications, restraints, and sitters ordered from the electronic health records | 6 months | 
| Percent of patient injurious behaviors reported | By extracting reports of biting, kicking, throwing, etc. from the electronic medical record | 6 months | 
| Percent change in nurse comfort and confidence in their ability to manage patients exhibiting disruptive, threatening or acting out behavior | By administering surveys to participants | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of unit nursing staff retention | By extracting rates from internal human resources records | 1 year | 
| Patient length of stay | By extracting data from the electronic health record | 6 months |