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

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2025-07-03 DOI:10.1002/jhm.70121

Courtney Enix MD, Angela Keniston PhD, MSPH, Ashley Jenkins MD, MSc, Claire Westcott PA, Kristin Furfari MD, Sneha Daya MD, Jeffrey L. Schnipper MD, MPH, Andrew Auerbach MD, MPH, Katie E. Raffel MD

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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.

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消除干扰：快速定性分析检查医院医生的经验导航行为升级事件。

背景：行为升级事件已成为司空见惯的急症护理设置。破坏性的患者行为会导致工作场所伤害，并可能危及患者护理和安全。尽管经常遇到行为升级，但在解决破坏性行为时，对医院医生的实践和观点的研究有限。目的：探讨医院医生在处理成人急症护理中行为升级事件时的经验和观点。方法：我们于2023年2月10日进行了一项快速定性研究，通过医院医学再造网络（HOMERuN）对19家美国医院的27名医院医学参与者进行了四个半结构化虚拟焦点小组的研究。讨论检查了行为升级的医院经验和对反应策略的看法。结果：我们的快速定性研究确定了四个关键主题。(1)许多医院缺乏识别有行为升级风险的患者或情况的策略。(2)跨学科合作被认为是必不可少的，但专门的响应团队往往不可用。(3)缺乏对破坏性行为的标准化方法和不充分的医院医生降级培训可能导致不同的反应。(4)有限的前瞻性措施，以预测升级和不一致的使用电子病历行为警报可能无意中使患者污名化。结论：急性护理环境中的行为升级事件在扰乱医疗服务的同时对患者和工作人员的安全构成重大风险。参与者强调了预测行为升级的有限策略，不一致的跨学科团队反应结构，以及汇报或事件回顾的最小机会。焦点小组强调需要建立支持以团队为基础的降级培训的系统，并将偏见和公平考虑纳入行为反应实践。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.