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Review
. 2020 Jul 3;1(5):898-907.
doi: 10.1002/emp2.12138. eCollection 2020 Oct.

Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation)

Lynn P Roppolo  1 , David W Morris  2 , Fuad Khan  2 , Rohini Downs  3 , Jeffery Metzger  1 , Tiffany Carder  4 , Ambrose H Wong  5 , Michael P Wilson  6
Affiliations
Review

Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation)

Lynn P Roppolo et al. J Am Coll Emerg Physicians Open. .

Erratum in

Abstract

Agitated patients presenting to the emergency department (ED) can escalate to aggressive and violent behaviors with the potential for injury to themselves, ED staff, and others. Agitation is a nonspecific symptom that may be caused by or result in a life-threatening condition. Project BETA (Best Practices in the Evaluation and Treatment of Agitation) is a compilation of the best evidence and consensus recommendations developed by emergency medicine and psychiatry experts in behavioral emergencies to improve our approach to the acutely agitated patient. These recommendations focus on verbal de-escalation as a first-line treatment for agitation; pharmacotherapy that treats the most likely etiology of the agitation; appropriate psychiatric evaluation and treatment of associated medical conditions; and minimization of physical restraint/seclusion. Implementation of Project BETA in the ED can improve our ability to manage a patient's agitation and reduce the number of physical assaults on ED staff. This article summarizes the BETA guidelines and recent supporting literature for managing the acutely agitated patient in the ED followed by a discussion of how a large county hospital integrated these recommendations into daily practice.

Keywords: Project BETA; agitation; physical assault; workplace violence.

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Conflict of interest statement

LR was the lead author, responsible for the overall manuscript and led the task force who developed the “agitation protocol and order set” initially designed for the emergency medicine residents at Parkland Memorial Hospital assisted by DM, FK, RD, JM and TC. DM contributed significantly to the initial draft of this article and designed Figure 1. FK was responsible for the psychiatric evaluation and restraint section and assisted RD with the pharmacology content. AW and MW provided significant contributions in the development of this manuscript and content review.The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Violence/agitation severity leveling and initial course of action. IM, intra‐muscular injection
FIGURE 2
FIGURE 2
Pharmacology algorithm: medication recommendations depend on most likely etiology of the patient's agitation 11 , 56
FIGURE 3
FIGURE 3
Correct application of restraints for severely agitated patients. Original image by Skylar Burchatz with permission
See this image and copyright information in PMC

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