Preventing Patient Violence in the Emergency Department

Guest Biography
Sarah Lohse earned her BSN degree from Southeast Missouri State University in 2004 and her MBA from Saint Louis University in 2008. She began her work as a bedside nurse and worked in both pediatrics and telemetry prior to working in leadership positions. After earning her MBA, Sarah worked as a team leader and nurse manager on a medicine/oncology unit. Three years ago, she began her current position as the Director of Behavioral Health Services at SSM St. Mary’s Health Center in St. Louis.
Sarah is passionate about making SSM a safer place for patients and staff alike. The interview you are about to hear focuses on an entity at the hospital called BERT, or the Behavioral Emergency Response Team. BERT is based on a team approach that brings medical and behavioral health professionals together to work collaboratively when a patient is in the beginning stages of an acute crisis. The purpose is to distinguish between different kinds of escalating behavior early on and decrease the use of physical restraint.
Podcast Highlights
Here are a few of the highlights from my conversation with Sarah.
What conditions in the regional market contributed to the creation of BERT? (2:42)
“The conditions were that in the St. Louis area there were a lot of predisposing factors that contributed to the need for this. We had several other facilities in our region that had recently closed that had behavioral health support so we had started seeing an influx of behavioral health patients to our SSM facilities. While the behavioral health employees were CPI certified and had the training needed to provide care in de-escalation, the ancillary areas did not. They were suddenly seeing these patients because, as we know, our behavioral health patients have an increase in medical co-morbidities and they don’t always come straight to behavioral health.
We see a lot of patients that come into the emergency room for one reason; they may come in because they’re suicidal, but we discover that they have a raging wound that needs to be addressed so they go to medical and then they become escalated on medical, and they didn’t know how to de-escalate them. It had a lot to do with the conditions. There’s an increase in behavioral health patients, an increase in medical co-morbidities, and a lack of resources in the area to provide support to the medical units.”
On the beginning of culture change at SSM (5:24)
“When our VP, Dan Body, started in 2010 or 2011 . . . he really set the tone for what the culture should be. And so he set the tone for we need to really be a center for healing. We need to be here supporting patients. We changed a lot of our language. We don’t use verbiage such as ‘takedowns.’ We talk about physical interventions. We really adapted the CPI model and so once . . . I think that he started in 2010 and we were on a good path within behavioral health as to where our culture was moving. This was really taking it to the next step to reach out to the medical units to really say, ‘This is who we are and what we’re all about and we want to work with you to make sure that we’re all on the same page.’”
On the circumstances that made her passionate about BERT (7:07)
“Because I worked in medical and I knew where the gaps were, I really came in to behavioral health knowing that . . . I really came in to behavioral health understanding what the deficiencies were, so my lens was so different. So many people that work in behavioral health have always worked in behavioral health and that’s the only lens they have and that’s what they see. Coming from medical and not being exposed to behavioral health, I had so much to learn and I was really seeing things very differently.”
On the creation of the BERT team (8:28)
“I knew that I would need to involve nursing operations, security, and our operators at a minimum. We had a meeting with our administrative director of nursing operations, our team leader for security, as well as the person who’s over the operators, and said, ‘This is a vision for what we want to do. We want to create this team that’s going to provide a resource for the emergency department and medical units whenever a patient escalates. Here’s what we’re thinking but we need you guys to be a part of it. It can’t just be us. We need to work as a team. Are you on board? Are you supportive?’ They said, ‘Absolutely. Tell us what we need to do.’ They were just as excited as we were.”
On Code Strong vs. BERT (10:50)
“Before BERT, we had what’s called the Code Strong. A Code Strong was for any type of escalation. It was an overhead page so as soon as someone was escalating staff would call our emergency hotline number, which for us is 4444, tell the operator they needed a Code Strong, and then everyone who was available responded. The Code Strong is still in place. We haven’t gotten rid of Code Strong. The idea of BERT is to supplement it because you are going to have patients that are going to go from zero to 100, that are going to go from zero to super escalation in two seconds flat, and you do need a lot of people to respond to that. BERT is designed to supplement it in when you know someone is escalating.

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