Implementation and Evaluation of a High-Fidelity,Interprofessional Simulation Project Using Standardized Patients to Address Aggression in a Psychiatric Emergency Department

Abstract

Introduction

Increased aggression in a regional Comprehensive Psychiatric Emergency Program (CPEP) led to a significant rise in physical assaults, restraints, and use of security personnel. Root cause analysis revealed a need for more extensive training on de-escalation, teamwork and communication.

Aims:

This quality improvement project evaluated the impact of an interprofessional, high-fidelity simulation project on interdisciplinary collaboration to manage de-escalation and aggression safely and effectively.

Methods:

Interdisciplinary team members (N = 171 nurses, psychiatrists, social workers, crisis specialists, and safety officers) participated in a 2.5-hr educational initiative that included Crisis Prevention Intervention (CPI) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) interventions, high-fidelity simulation using standardized patients, observation, and debriefing. Quantitative data collection and analysis included the use of the Confidence in Coping with Patient Aggression Instrument (CCPAI), TeamSTEPPS Perception Questionnaire (T-TPQ), pre–post data on restraints, injuries, and an educational survey. A qualitative analysis of debriefing themes was also performed.

Results:

Statistically significant improvement was noted in individuals’ confidence to manage aggression. In addition, data collected over a 5-month period before and after simulation demonstrated a 35% reduction in restraints and a 52% reduction in injuries. Interestingly, quantitative evidence revealed no changes in perceptions of teamwork. Results from the educational survey highlighted the positive impact of standardized patients and debriefing, and gaining new insights into patient care. Qualitative analysis of debriefing themes revealed educational opportunities to improve communication, role clarity, de-escalation, and insights into patient impact.

Conclusion:

The use of high-fidelity simulation with standardized patients has the potential to strengthen interdisciplinary collaboration to safely manage aggression in an acute psychiatric setting.