Psychiatric emergencies constitute over 12% of emergency department (ED) visits. Standardized measures like the Behavioral Activity Rating Scale (BARS) assist clinicians, nurses and behavior health specialist in quickly identifying and treating agitation in the acute emergent setting. Use of BARS in the emergency room setting to assess agitation and predict violence was studied with significant efficacy and reliability (p=<.001). We anticipate implementing BARS in the Adult ED will help staff assess patient agitation, initiate timely and safe treatment, and feel safer in their workplace. Staff, behavioral health technicians, nurses, and physicians will be trained on the use of the BARS and encouraged to use it for appropriate patients in the ED. We will track utilization of the BARS and measure utilization of intramuscular benzodiazepine and antipsychotic as a process measure. The outcome measure will be decreased episodes of violence as evidenced by decreased restraint utilization.

Aim 1: Implement a numerical, validated screening scale called the Behavior Agitation Rating Scale in the Emergency Department into Epic to improve standardization in early identification of agitation.

Aim 2: Measure and reduce the utilization of restraints, time spent in restraints and emergent involuntary medications.

Aim 3: Evaluation and analysis of perceptions and feelings related to staff safety and burnout based on pre and post implementation survey data.

The electronic build and design have been in process for over a year at University of Chicago Medical Center (UCM) and is in the final stages of production. We are a talented and motivated multidisciplinary team of physicians, nurses, behavioral health specialists, pharmacists and EPIC analysts who desire to study the implementation of the BARS and we will need support to do so. Our team would evaluate the perceptions of safety from diverse group of staff members with pre and post surveys, measure compliance with utilization of the rating scale with a daily Epic report and effectiveness of the intervention with reduced utilization of restraints.

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Epic Access