Hailey Tran
Code BERT, short for Behavioral Emergency Response Team, is a team of interdisciplinary, psychiatrically trained professionals who respond to behavioral emergencies in hospitals. The team is designed to protect staff and identify patients who may benefit from specialized psychiatric consult services. BERTs are meant to address the gap in the response to psychiatric emergencies, coping stress reactions, and iatrogenic injuries, which are often not treated with the same urgency as acute medical issues.
| Characteristics | Values |
|---|---|
| Full Form | Behavioral Emergency Response Team |
| Objective | Protect staff and identify patients who would benefit from specialized consult services |
| Team Members | Advanced practice providers (APPs), certified registered nurses (CRNs), behavioral analyst, resident, security officers, nurse manager or designee, patient engagement specialist, psychiatrist |
| Activation | A staff member will call the operator who will then verbally page "Behavioral Emergency Response Team" and the location three times |
| Availability | 24/7 |
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What You'll Learn
- Code BERT is short for Behavioral Emergency Response Team
- BERT is a coordinated crisis response team
- The team consists of advanced practice providers, certified registered nurses, a behavioral analyst, and a resident
- BERT is activated for patients who decompensate solely psychiatrically
- BERT is not the only solution for ethical interventions for behavioral emergencies
Code BERT is short for Behavioral Emergency Response Team
Code BERT, short for Behavioral Emergency Response Team, is a team of interdisciplinary, psychiatrically trained professionals who respond to behavioral emergencies in hospitals. The team consists of the patient's care team, security officers, nurse managers, patient engagement specialists, and psychiatrists. BERTs are activated when a patient is experiencing a psychiatric emergency, such as aggression, agitation, self-injury, or combativeness, and their purpose is to provide immediate de-escalation, assessment, and treatment to prevent harm to patients and staff.
The implementation of BERTs allows for a more ethical and proactive approach to behavioral emergencies, filling a gap in traditional security emergency codes and medical rapid response teams (RRTs). Traditional security codes often promote aggression and treat patients as intruders, while medical RRTs may not include trained personnel to address acute behavioral crises. BERTs, on the other hand, provide a flexible and collaborative solution that can be implemented in various hospital settings, regardless of psychiatric staffing and financial resources.
One example of a BERT in action is the one based at Golisano Children's Hospital in Rochester, New York. This BERT is a coordinated crisis response team that assists when a child's behavior jeopardizes their safety or the safety of others. The team includes advanced practice providers, certified registered nurses, behavioral analysts, and residents, all with specialized training in de-escalation and mental health. They are available 24/7 to provide early identification, assessment, and treatment for patients at risk of or experiencing acute behavioral events.
The activation process for a BERT typically involves a staff member initiating the response by calling the operator and verbally paging "Behavioral Emergency Response Team" and the location. This prompt response helps to address the immediate needs of patients experiencing psychiatric emergencies and ensures the safety of both patients and hospital staff.
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BERT is a coordinated crisis response team
BERT is an acronym for Behavioral Emergency Response Team. It is a coordinated crisis response team that provides immediate de-escalation and care to patients experiencing behavioural or psychiatric emergencies. BERT consists of an interdisciplinary team, including advanced practice providers (APPs), certified registered nurses (CRNs), a behavioural analyst (if available), a resident, the team caring for the patient, security officers, a nurse manager or designee, a patient engagement specialist, and a psychiatrist.
The primary role of BERT is to respond to behavioural emergencies, such as when a patient is exhibiting escalating or violent behaviour, aggression, agitation, self-injury, or combativeness. The team is trained to communicate effectively, de-escalate situations, and safely intervene to protect both patients and staff. BERT can also assist in situations involving patients' family members and visitors.
BERT fills a critical gap in inpatient hospital settings, where security emergency codes and medical rapid response teams (RRTs) often fail to address acute behavioural and psychiatric needs adequately. BERT provides a more ethical and patient-centred approach, integrating clinical oversight, patient advocacy, and security assistance to closely monitor and address potential dangers.
The flexible design of BERT allows for its implementation in various hospital settings, regardless of geographic location, psychiatric staffing, or financial resources. It offers a proactive and collaborative solution to behavioural emergencies, prioritising early identification, assessment, and treatment to prevent harm and ensure the safety of all involved.
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The team consists of advanced practice providers, certified registered nurses, a behavioral analyst, and a resident
The team is comprised of a variety of skilled medical professionals, each with distinct roles and responsibilities.
Advanced practice providers are licensed healthcare professionals who work under the supervision of a physician. They include physician assistants and certified registered nurse practitioners (CRNPs). Physician assistants hold a master's degree and are trained in medical models of care, surgical training, and overall health and wellness. CRNPs, on the other hand, have a master's or doctoral degree and receive advanced nursing education and training.
Certified registered nurses are licensed healthcare professionals who have graduated from an approved nursing program and passed the National Council Licensure Examination (NCLEX-RN). They provide and coordinate patient care, educate patients and the public about health conditions, and work as part of a team with other healthcare professionals. Some certified registered nurses pursue further specialization, such as becoming certified registered nurse anesthetists (CRNAs) or certified nurse midwives. CRNAs provide anesthesia in collaboration with surgeons, dentists, and other specialists, while certified nurse midwives focus on reproductive health and the care of women and infants.
A behavioral analyst is a specialist who works with individuals with developmental disabilities, particularly those with Autism Spectrum Disorder (ASD). They use Applied Behavior Analysis (ABA) techniques to help their patients manage daily life skills and social interactions. In a hospital setting, they collaborate with other healthcare professionals to create behavior modification plans and provide therapeutic services.
Finally, a resident, or resident physician, is a qualified doctor who is undergoing postgraduate training under the supervision of a senior clinician. They have graduated from an accredited medical school and hold a medical degree. The residency program allows them to gain practical experience and specialize in a particular field of medicine or surgery. The duration of residencies can vary, typically ranging from two to seven years.
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BERT is activated for patients who decompensate solely psychiatrically
BERT, or Behavioral Emergency Response Team, is a team of interdisciplinary, psychiatrically trained professionals who respond to behavioral emergencies in hospitals and other clinical settings. The team is activated for patients who are experiencing a psychiatric crisis and decompensating solely due to psychiatric reasons. This may be evidenced by signs of aggression, agitation, self-injury, or combativeness.
The goal of BERT is to provide immediate de-escalation and care to patients in crisis, preventing harm to themselves or others. BERT members include security staff, clinicians, psychiatric nurses, behavioral analysts, and psychiatrists. They work together to de-escalate the situation, provide early identification and assessment of the patient's needs, and connect them with the appropriate services.
BERT is activated when a staff member initiates the response by calling the operator, who then pages the BERT members. The team is expected to arrive within 5 minutes of activation and is available 24 hours a day, 7 days a week. BERT members are trained in de-escalation techniques and work to build rapport with the patient, minimize the need for security intervention, and provide a proactive approach to patient and staff safety.
Prior to the implementation of BERT, if a patient decompensated psychiatrically, a rapid response team (RRT) would be called, often resulting in a Code Grey, which alerts staff to potentially combative persons. However, this was not an efficient use of resources and caused delays in patient care. BERT aims to address this by providing a specialized response team for behavioral emergencies, improving patient care, and reducing workplace violence.
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BERT is not the only solution for ethical interventions for behavioral emergencies
Code BERT, or Behavioral Emergency Response Team, is a team of interdisciplinary, psychiatrically trained members who respond to behavioral emergencies in hospitals. The team's primary goal is to protect staff and provide specialised care to patients exhibiting escalating or violent behaviour. While BERT has proven effective in reducing assaults on staff and increasing staff satisfaction, it is not the sole solution for ethical interventions in behavioural emergencies.
Firstly, BERT implementation heavily relies on full-time psychiatry staff and dedicated psychiatric funding, which may not be feasible for hospitals with limited resources. This limitation underscores the importance of exploring alternative interventions that are less dependent on extensive psychiatric resources.
Secondly, BERT is primarily focused on responding to acute behavioural crises rather than addressing underlying psychiatric conditions. While de-escalation techniques are crucial in managing immediate emergencies, a comprehensive approach should also incorporate proactive psychiatric consultations to treat the underlying mental health issues contributing to the patient's behaviour. This holistic approach aligns with the principle of beneficence, which mandates treating patients using the best available practices that address both acute symptoms and underlying causes.
Additionally, the presence of security enforcement during behavioural emergencies can foster mistrust and intensify behavioural dysregulation, potentially leading to iatrogenic physical or psychological injury. Instead of relying solely on security interventions, hospitals should prioritise compassionate, patient-centred responses that balance the need for clinician safety with ethical patient care. This includes exploring alternative workplace safety measures that minimise the negative impact on patient trust and wellbeing.
Furthermore, ethical considerations arise when discussing behavioural interventions for individuals with intellectual disabilities (IDs), particularly those who lack capacity. While behavioural treatments can help manage challenging behaviours in people with IDs, coercive treatment methods raise several ethical and medico-legal concerns. In such cases, it is essential to explore alternative interventions that respect the autonomy and rights of individuals with IDs while also ensuring their safety and well-being.
While BERT plays a crucial role in hospitals, it is essential to acknowledge that ethical interventions for behavioural emergencies extend beyond this framework. By exploring and implementing a range of evidence-based practices, hospitals can enhance the quality of care provided to patients experiencing behavioural crises and ensure that the specific needs of each patient are addressed effectively and ethically.
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Frequently asked questions
BERT stands for Behavioral Emergency Response Team.
Code BERT is a security emergency code used in hospitals to address psychiatric emergencies, coping stress reactions, and iatrogenic injuries.
The team consists of the patient's care team, security officers, a nurse manager or designee, a patient engagement specialist, and a psychiatrist.
Code BERT is initiated when a patient is experiencing a psychiatric emergency, exhibiting signs of aggression, agitation, self-injury, or combativeness, and posing a potential risk to themselves or others.
The purpose of Code BERT is to provide immediate de-escalation, assessment, and treatment by a trained and skilled interdisciplinary team to prevent harm to patients and staff members.
