(203) The ABCs of Agitation Management: A Collaborative Education Approach

Presenting Author(s)

Suan Lee, MD (she/her/hers)

Resident
Maimonides Medical Center
Brooklyn, New York

Co-Author(s)

CD

Christine DeCaire, MD

Resident
Maimonides Medical Center
Brooklyn, New York
LM

Liad Maslaton, MD

Resident
Maimonides Medical Center
Brooklyn, New York
Shruti Tiwari, MD

Assistant Professor
Maimonides Medical Center
Brooklyn, New York
Sara Carlini, MD (she/her/hers)

Director, Perinatal Psychiatry
Maimonides Medical Center
Brooklyn, New York

Disclosure(s):

Suan Lee, MD: No financial relationships to disclose

Abstract: Background/Significance
Agitation management on medical units presents a unique challenge and requires a multi-faceted approach that identifies potential medical causes of agitation while applying the most appropriate treatment strategies to each case (Garriga, 2016). Internal Medicine (IM) trainees at our Brooklyn-based community hospital receive no formal training on verbal de-escalation, non-pharmacological interventions, and pharmacological interventions for the management of agitation. Furthermore, there are no ACGME requirements for any specific psychiatric training in IM programs, making this education deficit nation-wide (ACGME, 2022). This may result in trainees feeling overwhelmed and unprepared in these situations, which can potentially lead to negative outcomes for both staff and patients. The aims of this quality improvement initiative are to assess the IM trainees’ confidence and knowledge level in managing agitation in medically complex patients before and after a didactic developed by Psychiatry residents and Consultation-Liaison (CL) attendings.

Methods
IM residents in a Brooklyn-based community hospital were given a questionnaire to assess their confidence and knowledge level in managing agitation in acute medical patients. A presentation was created outlining relevant case examples to frame a practical discussion on agitation management in the acute medical setting. In this presentation, we discussed 1) verbal de-escalation techniques, 2) non-pharmacological interventions for safety, and 3) pharmacological management of agitation for a variety of medical conditions. A follow-up assessment will be conducted using a questionnaire to assess changes in confidence and knowledge in managing agitation for medical patients. Data from the pre- and post- questionnaires will be analyzed and results presented.

Results
There are 107 IM trainees in the program and there were 33 pre-surveys completed. The post-survey is ongoing, and as such, results are pending.

Conclusion/Implications
Education provided by Psychiatry for IM trainees on the management of agitation in medically ill patients is expected to improve the confidence and knowledge of those trainees in managing these challenging clinical scenarios and thereby improve patient and staff safety. Integration of this education into the standard of training would be expected to fill a knowledge gap in IM training, and CL Psychiatry is uniquely suited to advancing psychiatric education for IM trainees in academic medical settings.

References
1. Garriga M, Pacchiarotti I, Kasper S, et al. Assessment and management of agitation in psychiatry: Expert consensus. World J Biol Psychiatry. 2016;17(2):86-128. doi:10.3109/15622975.2015.1132007
2. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in internal medicine. 2022. https://www.acgme.org/specialties/internal-medicine/program-requirements-and-faqs-and-applications/. Published February 7 2022. Accessed 14 March 2024.

Presentation Eligibility: Not previously published or presented.

Diversity, Equity, and Inclusion: Our community hospital serves a diverse geographical location. Minority populations, especially Black populations, are more likely to be physically and chemically restrained, leading to adverse outcomes. Chemical and physical restraints are overlooked traumatic experiences that may be preventable. Moreover, agitation management can be complicated by cultural factors such as language and perception of mental health treatment. Our internal medicine department has little training in agitation management. By providing a lecture series on agitation to residents including topics such as verbal de-escalation, we hope to prevent escalation in agitation management and ensure equitable care for all patients regardless of cultural identity.