Table 4.

Proposed Interventions to Improve Pediatric Acute Agitation Care

Theme	Exemplar Quote
Opening a behavioral observation unit with dedicated staff and space	“If you had a specialized area that was unique to caring for that patient population, then you could hire people with that skill and communication set.” (Nurse)
Asking screening questions in triage to identify risk of agitation	“What are some of the things the kids like, what helps their agitation? You already have it documented and you’ll be ready.” (Parent)
Creating personalized care plans in the electronic health record	“I think what would be nice for some of these kids who are repeat visitors is to have somewhere in their chart an emergency agitation plan.” (Physician) “For those who are like my son, it would be very helpful if the emergency room doctors would have at least an idea of who he is instead of just coming in the room.” (Parent)
Using a standardized agitation severity score	“This numerical scale, it kind of reminds me of acuity.” (Nurse)
Implementing a behavioral response team	“Bringing in expertise to the fray maybe a little sooner than later is probably a good idea. That’s one of the things a rapid response team might achieve.” (Physician)
Providing safe activities and environmental modifications	“Having some more kiddo-friendly, sensory-friendly distractions available would be great.” (Parent) “When I got in, it kind of calmed me down because… I really liked the design on the walls” (Adolescent).
Improving the handoff process	“I think things have gotten missed when a nurse went home at 11, 1, 2, 3, and then 7… what strategies worked, what have we tried.” (Nurse) “I always appreciate an introduction from one nurse to the next… [reviewing] medications and any pertinent diagnoses as well as what we’ve tried so far that did not work… That gives everybody a chance to be on the same page.” (Parent)
Educating staff	“Education. I just want education. I want the tools to take care of these patients. I have the tools to take care of every other patient. I think they deserve the respect and honor of people knowing how to take care of them in their most difficult times.” (Nurse) “A behavioral health nurse who is trained in de-escalation techniques… [would be my] number one draft pick.” (Parent)
Addressing bias and inequities	“If we start treating psychiatric patients as actual patients like we treat the kids with cancer, asthma, epilepsy, acute appendicitis, I think that we will give them better care… When we start to think of them like they belong in the emergency department, in their acute moment of distress we can equitably take care of them.” (Nurse)