De-escalating a Code Green at CentraCare Health
It’s a scene fraught with potential harm: an enraged patient in a hospital mental health unit has barricaded himself behind a door with a glass window. Clutched in his wildly waving fist he brandishes several scrub shirts, swinging them with aggravated force against the glass, furiously yelling that anyone who ventures near will be hurt.
A Code Green goes out overhead and quickly a security response team of some 15 people assemble, including a rookie staff member. Among them is James Gulbranson, a security officer of the hospital, a very good one, and a seasoned Certified Instructor of CPI’s Nonviolent Crisis Intervention®
James takes the lead and begins to verbally de-escalate the patient. He’s aware that the show of a small throng of people is further alarming the guy, and he’s aware that he’s modeling behavior for the rookie staff. He takes his time and works the de-escalation techniques he’s learned, keeping a keen eye on the patient’s behavior level. James goes beyond where he otherwise might have called for restraints.
Gradually, the patient de-escalates. The patience and expertise have worked. The scene ends with the patient sitting peacefully on his bed, where he has agreed to be quiet for half an hour. No physical contact or restraint was necessary, and no harm has been done.
The outcome, instead, is therapeutic rapport. All parties are safe, sound, and maybe even a little wiser.
Photo: Squaredpixels / iStock
The setting is St. Cloud Hospital, part of the CentraCare Health
system of central Minnesota, where this story occurred. We learned it from James when he and his partner, Paul Ruegemer, generously agreed to appear on Unrestrained
, the CPI podcast series.
Episode 26 of the CPI podcast is the first video entry in the series, and in it we have the privilege of presenting these two security professionals and Nonviolent Crisis Intervention®
and Prepare Training®
Certified Instructors with thousands of training hours between them for the 3,500 CentraCare Health system employees.
The CentraCare Health system includes 6 hospitals, 7 senior care centers, 18 clinics and numerous inpatient and outpatient specialty services. The rate of employees who have had CPI training is near 100%.
James Gulbranson Paul Ruegemer
The interview is divided into two parts: Part I
showcases a presentation that James and Paul gave at CPI’s Instructor Conference last July, titled Practice-Based Evidence
, concerned with the statistical validation of the effectiveness of the Nonviolent Crisis Intervention®
During this presentation, James and Paul discuss the history of CPI training at CentraCare Health, show staff training and incident reduction graphs, and discuss how they use CPI’s Crisis Development Model
℠ to improve staff safety and decrease risk.
From the presentation (12:12)
Paul Ruegemer: “As you can see, in fiscal year 2012 we were quite high with our [work] days modified [due to aggressive incidents], which means a staff member is unable to perform their normal duties and they are assigned other tasks throughout our hospital. They are obviously not doing patient care. And then our [work] days lost, obviously them being off.
As you’ve seen from our previous graph, percentage of staff trained [in Nonviolent Crisis Intervention®
training], there is a direct correlation as we get to fiscal year 2014, of that dropping off substantially of days modified and days lost, coinciding with our Nonviolent Crisis Intervention®
training. There’s no other variables that were factored into that. There’s nothing else that really changed at CentraCare, other than Nonviolent Crisis Intervention®
training being rolled out.”
- After CPI training, work days lost due to aggressive incidents dropped by 81%.
- After CPI training, work days modified due to aggressive incidents dropped by 69%.
- In the period between CentraCare’s fiscal years 2012 and 2015, worker’s compensation costs due to aggressive incidents dropped by 61%.
of the podcast features James and Paul discussing a team intervention approach known as B.E.R.T.
(Behavioral Escalation Response Team), which the hospital adopted as policy in 2013.
The purpose of a B.E.R.T. is to bridge the gap between the early stages of an incident and a high-level security alert, responding at a patient’s defensive stage when they appear to be escalating. Calling a smaller, specialized team had distinct advantages, including less patient agitation than a larger team might cause as well as less disruption of hospital staff. (St. Cloud only calls a B.E.R.T. code for patients.)
St. Cloud Hospital began a three-month trial of B.E.R.T. in 2013 for all CentraCare Health in-patient medical units except the ED and mental health, because those departments have a security presence constantly in place.
Notable in this presentation is the data about the percentage of time a Code Green (full-blown security alert) was averted and patient escalation prevented by a B.E.R.T. call—an average success rate of over 80% at the time of this podcast, with 100% reduction in certain months.
Watch the videos to learn about the successful implementation of CPI training and techniques as well as the team intervention approach known as B.E.R.T. throughout the CentraCare Health system.
To learn more about how CentraCare Health has reduced challenging and disruptive behaviors since implementing CPI training, check out this case study.