Newport, Va.-based Riverside Regional Medical Center implemented a behavioral response team after identifying gaps in workplace violence prevention, increasing reporting by 245% from 2024 to 2025 and enabling real-time intervention for escalating behavioral health situations.
The team is designed to support front-line staff across the hospital, outside of the emergency department, where specialized psychiatric and security resources are already embedded. Riverside reviewed 430 workplace violence and “near miss” cases between June and the end of February. Of those cases, 337 actions were taken.
“We really took a deep dive looking at our workplace violence prevention program and what we could do to kind of do better,” Mary Haigh, MSN, RN, senior director of emergency services, told Becker’s. “We definitely had underreporting of events, and we were noticing some trends in events that were occurring.”
She has seen an increase in behavioral health cases and complexity. Increasingly, patients are presenting with polysubstance abuse, which affects behavior and comorbidities.
Ms. Haigh said three elements drove the increase in reporting: a fair and just culture, including increased comfort with reporting; not creating more workload for nursing staff; and capturing actions taken to prove reports are being addressed.
“We switched the reporting from being a nursing task, and now our security does 100% of reporting, and there’s no nursing burden to report events,” she said.
In many cases, behavioral health resources existed but were deployed reactively. Ms. Haigh said the organization needed to find a way to respond before an event occurred.
“If we have the right resource in place, the subject matter expert at the bedside when it was needed in real time and not reviewing the case, we probably could have provided that resource in real time and prevented either a violent event from occurring or patient continuing to escalate,” Ms. Haigh said.
Emergency department psychiatric technicians serve as the team lead and are supported by a nursing supervisor, the security team and whichever unit leadership is available at the time to respond. The model was developed by mirroring the process of medical events and rapid response processes already in place.
The team model also does not require new hires. She said in many cases, behavioral health resources were being used, but there was no team approach.
In one of the team’s first responses, a patient had completed their inpatient medical care but still had behavioral health needs, with the situation escalating. The psych tech on the case was able to initiate the detention process, while the emergency department nurse connected with the medical nurse to discuss medication management.
“Just through engaging with the patient, the verbal deescalation, and then proactively getting medication on board,” Ms. Haigh said. “In that situation, we’re able to prevent the patient from escalating to something like a workplace violence event.”
The patient was detained and sent to a behavioral health facility within the organization for inpatient psychiatric care in less than 12 hours.
The organization is also building an aggression risk assessment to help identify patients who are at risk for escalation. The assessment has already been launched in all emergency departments, with promising results. The emergency department at the center has reduced law enforcement usage by 62% since implementing the risk assessment.
“We absolutely have seen a decrease in physical violent events in the emergency department since using that, and [we] are getting ready to launch it systemwide in units that will integrate into our Epic trackers to determine a list of high risk patients that the behavioral response team can then proactively review prior to even the clinical team requesting them to respond,” she said.
In addition to creating the response team, the organization built a secure group chat through Epic for psychiatric techs, who were then given iPhones, allowing staff to call for support.
“If you are a nurse on a unit and you don’t need a response and the patient’s fine but you don’t know how to handle a situation, you can securely chat with the site tech and get a response from somebody that probably does know,” she said. “Just having somebody they can lean on and reach out to in these situations has been really positive.”
At the Becker's Fall Behavioral Health Summit, taking place October 20–22 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
