Bringing the calm to crisis care

How one team created a role that changed the way we handle crisis care.

The Emergency Department: On any given day you can find it busy with the hustle and bustle of some of the most acute cases being triaged by our staff. In an environment with so much happening, the noise, movement, and atmosphere can sometimes lead to increased stress, especially for behavioral health patients.

And in this atmosphere, we also know that our staff is in a particularly vulnerable position: How do we provide quality care for patients experiencing distress or behavioral issues while keeping them and others safe?

So, knowing this, how do we make it better?

Left to right: Sam Patel, CSO; David Beltz, CSO; Katie Schneider, MSN, RN, CEN, Emergency Department staff nurse; Raymond Richardson, CSO

That’s the question that a cross-functional team comprised of Lance Clemsen, MS, LISW, emergency medicine, Jeff Vande Berg, MS, quality and operations improvement engineer, and Doug Vance, security director, among many others, launched a year-long study to answer.

Assembling the team was the first step; the second was creating a hypothesis.

“What if our security officers could build a relationship with patients, provide timely information, and reinforce crisis-coping strategies, all while updating the treatment team? Perhaps these efforts would enhance the therapeutic process, reduce disturbances, and improve the overall patient experience,” Vance says.

The team took that hypothesis and put it into action, training several security officers as psychiatric nursing assistants (PNAs). These staff members became versed in “just-in-time crisis intervention” to alert staff of early warning signs to any escalating tension. The goal was to not only improve overall safety but enhance the quality of care patients receive. These security officers would then become crisis stabilization officers or CSOs.

“We see this role as a continuation of the safety and security officer role,” Vance says. “We’ve found that it can reduce violence against PNAs and improve patient care in general.”

Results that speak for themselves

After 34 months, the study discovered that the CSOs were more empowered and more confident in their interactions with behavioral health patients and staff, and they reported feeling that their job was more rewarding.

“Our CSO security staff who trained as nursing assistants experienced zero injuries, even when involved in the most volatile situations in our institution,” Vance says.

“Patients who presented repeatedly to our Emergency Department often requested the CSOs for their care,” Clemsen reports.

And employees are noticing a difference, too.

“Knowing that we have the CSOs there for us in the Emergency Department—a place where situations can become volatile very quickly—brings peace of mind to the staff,” says Katie Schneider, MSN, RN, CEN, Emergency Department staff nurse. “Having their skill set on hand to utilize when needed is huge. They’re key members of the team and they make a difference in the care of our patients.”

Listening to our employees

As CSOs gather more information about patients, they meet monthly with social workers and PNAs to adjust their schedules and supervision tactics to meet the patients’ needs and improve service.

As a result, staff injuries decreased by half, and the behavioral health patients—who typically report the most negative perceptions of their care experience—also expressed more positive perceptions of staff and their overall experience in the unit.

The success of the CSOs also helped in forming the Crisis Stabilization Unit, specifically designed for people experiencing an emotional or psychiatric emergency.

When asked about next steps, Schneider sings the praises of the team and offers ideas for growth.

“Everyone on the team—from the providers, to the nurses, to the paramedics, and nursing assistants—understand how the CSOs work and why their role is valuable,” explains Schneider. “We’d love to see the addition of a dedicated pediatric CSO and pediatric crisis stabilization unit in the future.”

Do you have a story about a recent collaboration success? Share it in the comments! And make sure to share any quality and safety improvement ideas with your leader, or email qualityandsafety@uiowa.edu.

2 comments

  1. i am visually impaired / blind with traumatic brain injury and crisis stabilization unit helped me get in and get out and back to managing my missions in recovery, be back 4 outpatient wednesday

  2. Sam, David and Ray were beloved in their original roles on BHS, for many years. Each man was respected and deeply appreciated. They’ll be a great asset, going forward. I miss all of them.

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