Evaluating the Feasibility and Effectiveness of an Interdisciplinary Verbal De-Escalation and Implicit Bias Check Training for Agitation Management in the Emergency Department.

Purpose: Recent scholarship has revealed racial disparities in emergency department (ED) physical restraint use in agitation management. We implemented an interdisciplinary educational program that integrates discussions about the role of bias in physical restraint use with workplace violence (WPV) prevention strategies to increase awareness of implicit bias and comfort with verbal de-escalation among ED staff.

Patients and methods: In partnership with hospital security at a large urban academic medical center, we developed a 1-hour online WPV prerequisite course followed by a 2-hour multi-modal, in-person training consisting of 40 minutes each of didactics, an interactive defensive skills workshop, and case-based simulations with structured debriefings. From September 2022 to June 2023, all patient-facing ED staff were invited to participate and received a $100 gift card for program completion. Participants rated their confidence and comfort in various aspects of agitation management on a 5-point Likert scale before and immediately after via pre- and post-training surveys. Wilcoxon matched-pairs tests were employed for analysis.

Results: Of 91 participants, 72 (79%) completed the pre- and post-training surveys. Representing a wide range of ED role groups, 74% of participants were clinical staff and a majority had 0-5 years of experience (65%). Among all participants, there was a statistically significant improvement in confidence and comfort with the various aspects of agitation management across all 11 questions (p<0.001). A similar change was observed among the clinical staff (p<0.001), however, the degree of improvement observed among those with greater than 5 years of experience was less dramatic than among clinical staff with 0-5 years of experience.

Conclusion: Interdisciplinary multi-modal training can improve confidence and comfort with verbal de-escalation and implicit bias checks in team-based agitation management. Additional research is needed to understand if such integrated training can also reduce physical restraint use, racial disparities in restraint use, and WPV events.