524 - Managing Pediatric Psychiatric Agitation in the Emergency Department: A Simulated Experience

For those working in the pediatric healthcare system, the need for mental health resources is becoming more evident than ever. In examining the data from the National Survey of Children’s Health (2016-2020) there was a significant increase in mental health conditions, more specifically a 27% increase in anxiety and a 24% increase in depression.  Furthermore, it has been found that one in six children in the U.S. aged 6-17 have a treatable mental health disorder. Nearly half of these children with these disorders do not receive counseling or treatment from a mental health professional. These disturbing trends then put a higher burden on acute settings such as pediatric emergency departments (ED) when these patients present in crisis.

Objective:

A simulation was created to educate pediatric trainees regarding the acute management of an aggressive psychiatric patient following medical clearance. This was developed to address trainees’ knowledge gaps in de-escalation of an acutely agitated and aggressive patient in an ED setting.

Design/Methods:

This simulation was designed for pediatric residents and fellows in the ED. This simulation has been performed at two academic training centers. A debriefing guide and participant evaluation form were used. For optimal learning, articles were provided in multiple appendices for review prior to and after the simulation. This case can be adapted to a wide variety of clinical settings.

Results:

A total of 18 trainees, mostly pediatric emergency medicine fellows, were able to participate in this simulation. The scenario was rated on a 5-point Likert scale. All participants reported feeling more comfortable with both pharmacologic (M=4.0) and non-pharmacologic management (M=5.0) of an acutely aggressive patient in an ED setting following this simulation.

Conclusion(s):

This simulation was developed based on a need seen in the ED due to the current mental health crisis. Many trainees never received formal training in verbal and medical de-escalation of psychiatric patients. In review of the literature a pediatric simulation of this nature has not yet been published and is of great utility to all providers.