353 - Get MAD: Managing Agitation with De-escalation in the pediatric emergency department

Poster Number: 353
Publication Number: 353.21

Alexandria Georgadarellis, Yale-New Haven Children's Hospital, New Haven, CT, United States; Gunjan Tiyyagura, Yale School of Medicine, Cheshire, CT, United States; Marc Auerbach, Yale University - Pediatrics And Emergency Medicine, New Haven, CT, United States; Melissa L. Langhan, Yale university, New Haven, CT, United States

Background: Pediatric emergency department (PED) encounters for behavioral health concerns have drastically increased over recent years. Consensus guidelines support prioritization of non-pharmacologic approaches in prevention and de-escalation of agitation. Despite these recommendations, the number of children being restrained in the PED continues to rise. While uncommon, physical restraint has been associated with trauma, injury, and even death. Additionally, racial and ethnic disparities in restraint use have been shown.

Objective: This study aims to establish baseline attitudes, knowledge, and experience of interdisciplinary staff who care for agitated patients in the PED.

Design/Methods: A validated scale on attitudes toward patient aggression was adapted with consultation from experts in pediatric emergency medicine (PEM), psychiatry, and behavioral health. The survey was piloted with eight health care professionals. The final survey collected data on attitudes, knowledge, and experiences with agitated pediatric patients and was distributed electronically to child life specialists, milieu counselors, emergency department (ED) techs, observation assistants, security officers, nurses, advanced practice providers, PEM fellows, and PEM attendings. Results were analyzed using descriptive statistics.

Results: Sixty-five participants completed the baseline survey (response rate 44%; table 1). Most participants (69%) had been involved in the care of >3 agitated pediatric patients in the last 3 months. While 52% felt high quality care was often or always provided to pediatric behavioral health patients in the ED, 64% felt patients were rarely or sometimes verbally de-escalated without pharmacologic or physical restraint. The majority of respondents did not know that use of restraints in children in the ED has increased over time or that minority children are more likely to be restrained than their white counterparts (52% and 51% respectively). While 54% had received formal training on verbal de-escalation, only 21% were quite or extremely satisfied with their training. Participants preferred workshops/simulation (33%), online modules (26%), and self-directed learning (18%) for future training (figure 1).

Conclusion(s):

While interactions with agitated pediatric patients in the PED are common, staff are infrequently de-escalating patients without the addition of chemical or physical restraint, and there are misconceptions in the knowledge about the care of these patients. Current efforts on training in verbal de-escalation are focused on asynchronous learning.