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An Integrative Literature Review of Psychiatric Rapid Response Teams and Their Implementation for De-escalating Behavioral Crises in Nonpsychiatric Hospital Settings

Choi, Kristen R., PhD, MS, RN; Omery, Anna K., DNSc, RN, NEA-BC; Watkins, Anne Marie, DNP, MSHCA, RN, CENP

JONA: The Journal of Nursing Administration: June 2019 - Volume 49 - Issue 6 - p 297–302
doi: 10.1097/NNA.0000000000000756

OBJECTIVE To synthesize articles exploring the implementation of psychiatric rapid response teams (RRTs) for behavioral crises in hospital settings.

BACKGROUND Psychiatric/behavioral crises in nonpsychiatric hospital settings can lead to restraint use, staff injuries, and poor patient outcomes. Psychiatric RRTs may provide a solution, but they are a new, understudied intervention, and their implementation varies across institutions.

METHODS A systematic, integrative literature review of nursing and biomedical literature yielded 7 articles about psychiatric RRTs. Data were extracted on RRT structure, processes, outcomes, and implementation.

RESULTS Psychiatric RRTs were structured as a nurse-led, interdisciplinary intervention. When implemented using evidence-based models, they reduced security calls, restraint use, and staff injuries while moderately improving staff knowledge and self-efficacy. RRTs that included education, debriefing, and role modeling appeared to increase staff behavioral management skills and eventually reduced the need for RRTs.

CONCLUSIONS Psychiatric RRTs have demonstrated promise in quality improvement projects for reducing adverse outcomes related to behavioral health in hospitals.

Author Affiliation: Fellow (Dr Choi), National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, University of California, Los Angeles; Senior Director (Dr Omery), Clinical Practice Services, Southern California Region, Kaiser Permanente; and Chief Nurse Executive (Dr Watkins), Kaiser Permanente-San Diego and Zion Medical Centers, Los Angeles, California.

K.R.C. acknowledges fellowship support from the UCLA National Clinician Scholars and Kaiser Permanente Southern California.

The authors declare no conflicts of interest.

Correspondence: Dr Choi, University of California, Los Angeles, 1100 Glendon Suite 850, Space 900-20, Los Angeles, CA 90024 (

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Online date: May 14, 2019

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