Multidisciplinary Simulation-Based Verbal De-escalation Training Improves Staff Knowledge and Clinical Environment in an Urban Emergency Department.

Abstract

Objectives: Hands-on de-escalation training has been recommended for patient-facing emergency department staff by the Occupational Safety and Health Administration. Additionally, simulation-based learning has been shown to be effective at improving staff knowledge and management of agitated patients. The objective of this study was to evaluate the impact of a multidisciplinary education session on staff knowledge and confidence in verbal de-escalation and violent restraint use, in the clinical environment in an urban emergency department.

Methods: A 90-min mixed didactic and standardized patient encounter educational course with formal debriefing was developed. Learners included nurses, patient support associates, paramedics, and protective services officers from an urban emergency department. Data was obtained from standardized surveys. Lastly, changes to the clinical environment that occurred because of the educational intervention were captured.

Results: A total of 117/136 emergency department staff members (86%) completed the de-escalation training. Improved confidence (> 90% agree/strongly agree) in all learning objectives was reported immediately after training and maintained after 6 months. Additionally, the rate of violent restraint use trended down after intervention. Multiple hospital policies, including alterations to physical environment, arrival process, and communication, were enacted as a result of staff feedback during the education.

Conclusion: A multidisciplinary simulation-based educational course was successful in improving learner confidence in management and de-escalation of agitated patients. This education also led to changes in the clinical environment within the emergency department.