ED Staff Need to Focus on De-escalation With Agitated Patients

More that 1.7 million episodes of agitation occur annually in U.S. emergency departments and are a leading cause of patient suffering and staff injuries, said Garland Holloman, M.D., at APA’s Institute for Psychiatric Services in San Francisco this past weekend. Holloman, director of psychiatric emergency services at the University of Mississippi Medical Center in Jackson, led a 30-person panel of the American Association for Emergency Psychiatry to develop new guidelines for diagnosing and treating agitation. Existing guidelines focus on mainly pharmacological strategies to deal with agitated patients, but other factors, like verbal de-escalation and medical evaluation, should be included as well, he said.

That can be a complex process. “Emergency department staff need to use techniques of verbal de-escalation while simultaneously managing physical medical diagnosis and treatment,” said Holloman. “The goal is to help the patient regain control.” Avoiding overmedication of patients and lessening the need for seclusion and restraint can not only reduce injuries to patients and staff but also encourage patients to be more trustful and more cooperative in their treatment, he said. For more information, see Clinical Manual of Emergency Psychiatry, published by American Psychiatric Publishing.

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