Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety

摘要

Background: Unexpected situations of workplace violence are occurring in the United States at increasing rates in healthcare environments, warranting increased attention to processes supporting safety for health care workers. At a large, academichospital, two patient safety incidents had occurred in a two-year period in which a patient had become violent at the timeof admission from the emergency department (ED) to the medical unit.Methods: A multidisciplinary quality improvement (QI) team was formed to address the risk of violent patient events.Using two iterative Plan–Do–Study–Act (PDSA) cycles, the QI team designed and tested a huddle handoff communicationtool, the Potentially Aggressive/Violent Huddle Form. An ED nurse would initiate the huddle process by informing theadmitting unit that a patient at risk for violence was being admitted. The admitting care team would then call the ED teamso that both teams participated in the handoff call together. The huddle process occurred for 21 transfers in the first PDSAcycle and for 18 transfers in the second.Results: RNs from the ED and the six medical units reported feeling safe during the transfer process 100% of the timeduring both tests of change PDSAs (vs. 54.7% at baseline). In the ED, from the first test of change to the second test ofchange, satisfaction with the process improved from 53.3% to 75.0%.Conclusion: The huddle handoff communication tool and other methods to facilitate the transfer of potentially violentpatients have the potential to decrease the number and severity of violent incidents in the health care workplace.