Behavioral Emergency Response Team Alert Disparities in a Single-Site Pediatric Hospital.

Abstract

Background and objectives: A Behavioral Emergency Reponse Team (BERT) is a rapid response team for behavioral emergencies, which include clinical psychiatric emergencies, coping/stress reactions and physical or verbal conflicts.1 Use of BERT activations ("alerts") in inpatient pediatric populations is understudied. The objective of this study is to determine any differences by race for individuals receiving BERT alerts at a single pediatric hospital.

Methods: A cross-sectional retrospective review of all inpatient BERT alerts was conducted between January 1, 2018, and December 31, 2020. Primary outcome was presence or absence of a BERT alert during a single hospital admission (Financial Identification Number). A mixed-effects logistic regression model was conducted to test the association between race and BERT alert as well as physical restraint (PR) use, adjusting for age, gender, ethnicity, payor, and mental health diagnosis (MHD) and clustering at the patient level.

Results: A total of 683 alerts occurred between the years 2018 and 2020. Admissions for Black patients had higher odds (adjusted odds ratio [aOR], 2.1; 95% CI, 1.6-2.8; P < .001) of having a BERT alert. Admissions with private insurance had lower odds (aOR, 0.4; 95% CI, 0.3-0.5; P < .001) of any BERT alert. Having an MHD was associated with higher rates of BERT alert (46.7% vs 15.0%; P < .001) and PR use (aOR, 16.7; 95% CI, 5.1-55.0; P < .001).

Conclusion: Patients with Black race, government insurance, and MHD had a disproportionate number of BERT. MHD and BERT alerts are associated with increased PR use.