Practice Improvement|Articles in Press

Implementation of a Behavioral Emergency Response Team in the Emergency Department

Published:March 09, 2023DOI:



      Emergency nurses, physicians, and patients experience occurrences of workplace violence. Having a team to respond to escalating behavioral events provides a consistent approach to reducing occurrences of workplace violence and increasing safety. The purpose of this quality improvement project was to design, implement, and evaluate the effectiveness of a behavioral emergency response team in an emergency department to reduce occurrences of workplace violence and increase the perception of safety.


      A quality improvement design was used. The behavioral emergency response team protocol was created using evidenced-based protocols that have been shown to be effective in reducing the number of occurrences of workplace violence. Emergency nurses, patient support technicians, security personnel, and a behavioral assessment and referral team were trained in the behavioral emergency response team protocol. Data on occurrences of workplace violence were collected from March 2022 to November 2022. Postbehavioral emergency response team debriefings were conducted, and real-time education was provided after implementation. Survey data were collected to evaluate the emergency team members’ perceptions of safety and of the effectiveness of the behavioral emergency response team protocol. Descriptive statistics were calculated.


      The number of reported occurrences of workplace violence decreased by to 0 postimplementation of the behavioral emergency response team protocol. The perception of safety increased 36.5% postimplementation (mean 2.2 preimplementation, mean 3.0 postimplementation). In addition, an increase in awareness about reporting occurrences of workplace violence resulted from education and implementation of the behavioral emergency response team protocol.


      Postimplementation, participants reported an increase in the perception of safety. Implementation of a behavioral emergency response team was effective in reducing assaults toward emergency department team members and increasing the perception of safety.

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        • Zicko C.J.M.
        • Schroeder L.R.A.
        • Byers C.W.S.
        • Taylor L.A.M.
        • Spence C.D.L.
        Behavioral Emergency Response Team: Implementation improves patient safety, staff safety, and staff collaboration.
        Worldviews Evid-Based Nurs. 2017; 14: 377-384
        • Hameed A.
        • Sachit A.
        • Dabis H.
        Workplace violence against health care providers in emergency departments: an underrated problem.
        Indian J Forensic Med Toxicol. 2020; 14: 7
        • Sachdeva S.
        • Jamshed N.
        • Aggarwal P.
        • Kashyap S.
        Perception of workplace violence in the emergency department.
        J Emerg Trauma Shock. 2019; 12: 179-184
        • Aljohani B.
        • Burkholder J.
        • Tran Q.K.
        • Chen C.
        • Beisenova K.
        • Pourmand A.
        Workplace violence in the emergency department: a systematic review and meta-analysis.
        Public Health. 2021; 196: 186-197
      1. Workplace violence prevention standards. Joint Commission. Published 2021. Accessed October 18, 2021.

      2. The Joint Commission. Physical and verbal violence against health care workers. Sentinel Event Alert. Published April 17, 2018. Accessed October 18, 2021.

        • Samuels S.K.
        • Hunt S.
        • Tezra J.
        Patient violence against healthcare workers.
        J Bus Behav Sci. 2018; 30: 127-128
        • Al-Qadi M.M.
        Nurses’ perspectives of violence in emergency departments: a metasynthesis.
        Int Emerg Nurs. 2020; 52100905
        • Rajwani A.
        • Clark N.
        • Montalvo C.
        Understanding best practices in implementation of behavioral emergency response teams through a scoping review.
        J Am Psychiatr Nurs Assoc. 2022;
      3. Ross B. Prescription for safety: preventing workplace violence in health care. Risk Management. Published 2020. Accessed November 28, 2021.

        • Prisma health
        FY20 highlights and statistics.
        • Prisma health
        FY21 highlights and statistics.
      4. Nonviolent crisis intervention. Crisis Prevention Institute. Published 2022. Accessed March 12, 2022.

        • Parker C.
        • Calhoun A.
        • Wong A.
        • Davidson L.
        • Dike C.
        A call for behavioral emergency response teams in inpatient hospital settings.
        AMA J Ethics. 2020; 22: E956-E964
        • Lim M.C.
        • Jeffree M.S.
        • Saupin S.S.
        • Giloi N.
        • Lukman K.A.
        Workplace violence in healthcare settings: the risk factors, implications and collaborative preventive measures.
        Ann Med Surg (Lond). 2022; 78103727
        • Kibunja B.K.
        • Musembi H.M.
        • Kimani R.W.
        • Gatimu S.M.
        Prevalence and effect of workplace violence against emergency nurses at a Tertiary Hospital in Kenya: a cross-sectional study.
        Saf Health Work. 2021; 12: 249-254
        • Tomágová M.
        • Bóriková I.
        • Lepiešová M.
        • Čáp J.
        Nurses’ experience and attitudes towards inpatient aggression on psychiatric wards.
        Cent Eur J Nurs Midwif. 2016; 7: 462-469


      Angela M. Bruccoli is a Director of Emergency Services, Prisma Health Baptist and Baptist Parkridge, Columbia, South Carolina. ENA SC Central Chapter.