De-escalation Training Reduces Pediatric Restraint Use Disparities
Publication Title: Don’t Get MAD
Summary
- Question
- This study examined the impact of de-escalation training on the attitudes, knowledge, and behaviors of interdisciplinary staff caring for agitated pediatric patients in a pediatric emergency department (PED). The researchers aimed to evaluate whether the training influenced staff perspectives on managing agitation and improved their use of verbal de-escalation techniques instead of physical restraints.
- Why it Matters
- Managing acute agitation in children is critical for providing safe, compassionate care in emergency settings. Agitation, defined as excessive verbal or motor behavior, can escalate into safety risks for patients and staff. While verbal de-escalation techniques are recommended as a first-line approach, physical restraints are often overused, particularly in children from racial and ethnic minority groups. This study addresses the need for effective training to reduce reliance on restraints, improve staff confidence in managing agitation, and promote equitable care practices.
- Methods
- The researchers implemented asynchronous, multi-faceted de-escalation training as part of a quality improvement initiative in an urban PED. Training materials included visual aids, podcasts, an online module, and badge cards. Eligible participants included nurses, physicians, security staff, and other care team members. Pre- and post-intervention surveys assessed changes in attitudes, knowledge, and self-reported behaviors. Surveys included the Management of Aggression and Violence Attitude Scale (MAVAS) and additional questions on agitation management.
- Key Findings
- Post-training, staff demonstrated improved attitudes and knowledge about managing pediatric agitation. Participants were less likely to believe that aggression is difficult to prevent or caused solely by internal factors like mental illness. They also showed increased awareness of racial disparities in restraint use, with recognition that children from minority groups are more likely to experience restraints. Additionally, staff were more likely to believe that verbal de-escalation techniques were frequently used in the PED, though their comfort level in using these techniques did not significantly change.
- Implications
- The findings suggest that de-escalation training can positively influence staff attitudes and knowledge, leading to a greater focus on non-restrictive strategies for managing agitation. This approach has the potential to reduce physical restraint use, minimize trauma for patients, and address disparities in care. As the training materials were low-cost and easy to implement, they could be adopted in various healthcare settings to improve outcomes for agitated pediatric patients.
- Next Steps
- The authors recommend further research to identify the most effective de-escalation techniques and explore their impact on patient outcomes. They also highlight the need for interactive training methods, such as simulations, to enhance staff confidence and skill in managing agitation.
- Funding Information
- This research was supported by the Pediatric Fellow Academic Funding Award from the Yale School of Medicine. Yale University also provided funding and support for this research.
Full Citation
Georgadarellis A, Shabanova V, Hoffman P, Tiyyagura G, Auerbach M, Langhan M. Don’t Get MAD. Pediatric Emergency Care 2025, 42: 186-192. PMID: 41422423, DOI: 10.1097/pec.0000000000003526.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.
Authors
Alexandria G. Georgadarellis
First AuthorMelissa Langhan, MD, MHS
Last AuthorProfessor of Pediatrics (Emergency Medicine) and Emergency Medicine
Additional Yale School of Medicine Authors
Other Authors
Research Themes
Keywords
Concepts
- Pediatric emergency department;
- De-escalation training;
- Restraint use;
- Post-intervention;
- Training intervention;
- Agitated patients;
- Tertiary care pediatric emergency department;
- Pediatric emergency department staff;
- Urban tertiary care pediatric emergency department;
- Physical restraint use;
- Acute agitation;
- Quality improvement initiatives;
- Post-intervention surveys;
- Behavioral health emergencies;
- De-escalation techniques;
- Management of aggression;
- Patient aggression;
- Self-reported behavior;
- Staff care;
- Pediatric agitation;
- Improvement initiatives;
- Baseline survey;
- Racial disparities;
- Effective interventions;
- Electronic survey