FC51: A Big BIT: Utilizing Behavioral Intervention Team Approaches to Improve the Care of Older Adults on Med-Surg Units

Abstract

Background: Older adults may exhibit behavioral disturbance while medically hospitalized. Restlessness, removing medical devices, or wandering may lead to sentinel events including falls, elopements, or violence. The traditional consultation-liaison model addresses challenging or high-risk behaviors but is often reactive and may lead to missed opportunities. The interdisciplinary Behavioral Intervention Team (BIT) was implemented on the campus of Prisma Health Baptist Hospital in Columbia, SC to address and anticipate the need for behavioral health support on medical units.

Methods: A pilot BIT program was implemented in September 2019. Two psychiatric nurses were embedded on med-surg units as a part of medical and psychiatric interdisciplinary teams. After obtaining approval from the Prisma Health Institutional Review Board, a retrospective review was conducted to evaluate the correlation between BIT interventions and patient safety events. Two time periods were examined: six months with early-BIT efforts and six months with expanded-BIT efforts. Medical records and safety reports were reviewed, and statistical analysis was conducted in SAS Enterprise Guide 8.3. Statistical significance was based on associated p- values (p < 0.05).

Results: Of admitted patients during the study period (N = 1413), almost half were age 65+. Pre- existing psychiatric diagnoses were present in 58% of cases with mood, anxiety, and neurocognitive disorders being most common. A majority of patients were on psychotropic medications during both study periods; however, there was a significant decrease in the use of psychotropic medications with expanded-BIT efforts (71.2% vs 61.3%, p < 0.001). In comparing early-BIT efforts to expanded-BIT efforts, significant reductions in workplace aggression (6.7% vs 2.3%, p < 0.001), use of restraints (5.8% vs 3.4%, p = 0.034) and need for security (4.2% vs 0.8%, p < 0.001) were observed. Geriatric subgroup analysis demonstrated a significant decrease in the need for security only (4.6% vs 0.6%, p < 0.001).

Conclusions: Engaging BIT significantly reduced aggression, restraint use, and security interventions. As psychiatric comorbidities continue to impact overall treatment plans, care teams will need to prevent high-risk behaviors and events. Implementing an interdisciplinary BIT is feasible and effective in reducing negative outcomes.