Oral Papers: Delirium & Agitation
Significance: Leadership and team work standards for optimizing patient outcomes exist in medical emergencies and surgical procedures. However, to date there has been minimal consideration of these areas for acute agitation management. The goal of this project is to translate leadership theory concepts and skills, as well as healthcare teamwork best practices, into actionable guidance for acute agitation management.
Methods: A PubMed literature search was performed for agitation management, leadership and teamwork in psychiatry. EBSCO Complete literature search was also performed for selected relevant topics in leadership theory. Additional resources included leadership theory texts and in-person interviews on agitation management education and TeamSTEPPS instructions.
Results: The PubMed search for application of leadership theory and teamwork principles to agitation management in psychiatry yielded no results. Three articles described rapid response team implementation for acute agitation management. Literature on leadership skills and team work approaches in the medical context focused on “non-technical skills” in procedures and TeamSTEPPS® standards. Additional leadership skills and concepts were identified as valuable for translation to acute agitation management. One textbook on psychiatric leadership was also identified.
Discussion: Team work and leadership skills, while considered “non-technical,” have been translated for an acute medical emergency management approach by the United States government as TeamSTEPPS (AHRQ 2019), though no psychiatric literature translates these skills for acute agitation management. The team structure and activation algorithm for agitation rapid response team systems have been described (Loucks 2010, Peska 2012, Zicko 2017,), though provides limited teamwork or leadership guidance in the actual clinical situation. We discuss the applicability of the five major areas of TeamSTEPPS to acute agitation management. Additional relevant content identified as potentially valuable for agitation management includes: conflict resolution skills, power dynamics, cultural competence, management of medical personnel physical and psychological safety, emotional intelligence, group affective tone, and dark-side leadership awareness.
Conclusion: Team work approach and leadership skills have received very limited attention in acute agitation management literature, but may offer vital knowledge, skills, and attitude development to improve outcomes. Greater academic study and education for trainees on these aspects of agitation management could optimize patient care and lessen deleterious effects of care for medical personnel.
Agency for Healthcare Research and Quality. AHRQ TeamSTEPPS Implementation Guide. Retrieved from: Agency for Healthcare Research and Quality: < http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/implguide.html >. Accessed 3 Jan 2019.
Loucks J, Rutledge DN, Hatch B, Morrison V; Rapid response team for behavioral emergencies. J Amer Nurses Assoc 2010;16(2):93-100.
Pestka EL, Hatteberg DA, Larson LA, Zwygart AM, Cox DL, Borgen EE; Enhancing safety in behavioral emergency situations. Medsurg Nursing 2012;21(6):335-341.
Zicko JK, Schroeder NC, Byers WS, Spence DL; Behavioral emergency response team: implementation improves patient safety, and staff collaboration. Worldviews on Evidence-Based Nursing 2017;14(5):377-384.