Defusing disruption: A rapid qualitative analysis examining hospitalist experiences navigating behavioral escalation events.

Abstract

Background: Behavioral escalation events have become commonplace in the acute care setting. Disruptive patient behaviors contribute to workplace injuries and can compromise patient care and safety. Despite frequently encountering behavioral escalation, limited research exists on hospitalists' practices and perspectives when addressing disruptive behaviors.

Objective: To explore hospitalists' experiences and perspectives when navigating behavioral escalation events in adult acute care settings.

Methods: We conducted a rapid qualitative study on February 10, 2023, with four semi-structured virtual focus groups involving 27 hospital medicine participants across 19 US hospitals via the Hospital Medicine Reengineering Network (HOMERuN). Discussions examined hospitalist experiences with behavioral escalation and perspectives on response strategies.

Results: Our rapid qualitative study identified four key themes. (1) Many hospitals lack strategies to identify patients or situations at risk of behavioral escalation. (2) Interdisciplinary collaboration is considered essential, yet dedicated response teams are often unavailable. (3) Lack of standardized approaches to disruptive behaviors and inadequate hospitalist training in de-escalation may lead to varied responses. (4) Limited proactive measures to anticipate escalation and inconsistent use of EHR behavioral alerts may unintentionally stigmatize patients.

Conclusion: Behavioral escalation events in the acute care setting pose significant risks to patient and staff safety while disrupting healthcare delivery. Participants highlighted limited strategies to anticipate behavioral escalation, inconsistent interdisciplinary team response structures, and minimal opportunity for debriefing or event review. Focus groups emphasized the need for systems that support team-based de-escalation training and incorporate bias and equity considerations into behavioral response practices.