Stepping onto hospital grounds can elicit anxiety in almost anyone and IWK teams work to help support patients and caregivers while delivering safe, quality care. But when a person responds with aggression, a Code White is issued.
Inherently tied to mental health – but actually related more to distress and coping – disruptive behaviour can result from emotional dysregulation, illness and/or impaired functioning.
Occupational Health, Safety and Wellness (OHSW) secured a $13,000 research grant from the Health Insurance Reciprocal of Canada to lead a project exploring the development of an IWK Behaviour Response Team.
The project is timely, with IWK Health reporting 216 Code White incidents in the last year, with 12 leading to staff injuries – a record high.
This is consistent with national trends, says Krista Stultz, manager, OHSW, as hospitals across Canada face rising pressures, staff shortages and long wait times. Public frustrations with access to care can show up as dysregulation and this leads to safety risks for patients, staff and physicians.
"Our teams do great work, but we know we can do better. With the right people in place, we can improve our response to create an even safer environment for patients, families, and staff," Stultz says.
"And safety is as much psychological as it is physical," she says, "These events can be traumatizing for both patients and staff."
A patient safety consultant, Natalie Nymark worked alongside Stultz to secure the grant.
"We're seeing aggression across IWK care areas, from patients and families to staff, not just physical aggression, but also verbal escalation," Nymark says. "A behavior response team will provide staff with an extra resource to call upon in those moments, who they know are experts in de-escalation. It protects and supports them when faced with an angry or frustrated parent or patient."
Nymark says promoting psychologically safe environments for staff is top-of-mind through this work.
"It's not just about physical injuries, but how these incidents affect the mental health of our teams – sometimes days and weeks following an incident. Will people come to work with extra anxiety? Will the event impact how they care for a patient? Supporting our staff is critical – even in the immediate debriefs this team could facilitate."
To build a model, train staff and begin a trial – the project will take a year, Stultz says, drawing on expertise in mental health, patient safety, trauma informed care, and emergency medicine.
The project team is proposing a clinically led response, with mental health expertise at the forefront. When implemented, the Behaviour Response Team may include a mental health nurse, mental health clinician, and protection service officers working together. This team would complement already existing training in trauma informed care and nonviolent crisis intervention which all Emergency Department staff and physicians utilize in working with patients and families.
In the future, Code White events will likely unfold similarly to a Code Blue, during which a multidisciplinary team responds to a medical emergency such as cardiac or respiratory arrest.
Currently, when a Code White is issued, Protection Services officers are on the front lines.
"Our Protection Services team is fantastic. They build relationships with our clients and develop a rapport," Stultz says. "But sometimes they are put in challenging situations and are making difficult judgement calls. I'm hoping this team will provide additional support in those situations."
Nymark says in addition to understanding nuances of different populations and age groups, mental health clinicians may be able to identify clinical presentations such as psychosis or mania and guide the response accordingly.
"A clinically-led response will also ensure we approach behavioural events with a trauma-informed lens," Nymark says. "In every patient care moment, we have to consider that every person is coming in with a story we may know nothing about."
Empathy plays a big role in those moments, Stultz says, affirming the value of a trained team to respond to behavioural emergencies.
"Patients need to be heard in those moments. They need reassurance that we understand they're scared, that they're with a sick family member, and to know that we're doing the best we can."
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