Peer Assault Care Team (PACT)
With roots reaching back over 150 years, Truman Medical Centers (TMC) is Kansas City’s essential healthcare system. We have two, acute care academic hospitals, a behavioral health (BH) program, a long-term care facility, and multiple primary care practices; our TMC Hospital Hill location is the busiest Level 1 Trauma Center in the city. Beginning June 2009 and continuing until September 2015, TMC Hospital Hill operated a BH Emergency Department where we served approximately 30,000 individuals over a six-year period. Our BH Acute Care capacity at Hospital Hill is two units/50 adult beds.
In our context, patients become escalated. We developed the Peer Assault Care Team (PACT) as an evidence-based, crisis-intervention program to provide “psychological first aid” to staff victims of patient assault. Since February 2015, each time a BHAC staff member has been assaulted (over 200 times to date), we dispatched a trained, peer Responder to provide immediate and ongoing emotional and practical support and to offer resources that include information about normal reactions to trauma, self-care guidelines, tips for family/friends, EAP information, and how to get follow up care from TMC and BCBS providers. The program has been very successful, supporting staff resilience and helping us retain good employees.
Though certainly not the only program out there that provides support to those in crisis (we drew inspiration from several sources), the Peer Assault Care Team (PACT) program is an innovation for our inner-city, safety net hospital. Before this, there was no organized, follow-up care for assaulted staff, a situation that contributed to low staff morale, both primary and secondary trauma, compassion fatigue, burnout, and staff turnover. The PACT process guarantees that all physically-assaulted BHAC staff are offered follow-up care and resources for support by high-quality, trained peers. Serving as a PACT Responder is a Clinical Ladder option for our staff, and though not all Responders choose this option, those who do are rewarded with a renewable, performance-based, 3% raise after six months of successful service on the PACT.
Since the beginning, we have shared our goals, challenges, and successes with TMC BH Leadership beyond our BH Acute Care units. This spring, we will implement the PACT at TMC’s Lakewood location on the Older Adult Psychiatric Unit (OAPU). We are also currently in discussion with TMC’s Corporate Nursing Leadership to expand the PACT to non-behavioral healthcare departments. Last spring, we presented at the Missouri Hospital Association’s Annual Behavioral Healthcare Conference, encouraging other institutions to adopt a similar program.
For the past two years, we have actively “worked out the kinks” so that we now have a system that can be easily implemented by other organizations. This system includes a specific recruiting process, detailed training, both written and skills testing, periodic evaluations, a detailed response process, tracking forms, and regular surveys/reviews that guarantee top-quality PACT Responders provide evidence-based, best practice, follow-up support to staff victims of patient assault.
The PACT is somewhat self-sustaining—our staff deserve care when they are traumatized, and they want to provide care to their peers. Surveys show continued, positive support for this program, and interest in the PACT continues to grow. We started with a team of 24 Responders; now we have more than twice that many, representing every discipline. Two key roles needed for success of the PACT are our Clinical Team Managers (who make assignments and provide coverage for assaulted staff and Responders to be away from the milieu) and an onsite, unit-specific PACT Coordinator. The PACT supports retention and resilience of staff, and this improves our patient care outcomes, organizational effectiveness, financial stability, and potential for long-term growth. As the region’s safety net hospital, all our community partners have a vested interest in the resilience of TMC staff so that the most vulnerable patients receive the best care possible.
Once we package our materials, we anticipate the PACT can be duplicated by any other organization with similar needs. One reason we are seeking this award is to fund that dream, perhaps providing a website, training for other organizations, etc.
We started the PACT as a trauma-informed approach to improve staff welfare, resilience, and morale, and according to staff surveys it has succeeded. We also saw the potential to impact patient care and financial stability by allowing us to retain our best employees. An interesting trend that has accompanied the implementation of the PACT is a significant decrease (around 50%) in the number of staff assaults from 2014 (before the PACT was implemented) to 2016 (after two years of the PACT program). We cannot claim that the PACT is the cause of this trend because we have implemented several other measures to reduce assaults over that time frame. However, we are encouraged that the PACT is part of a bigger initiative to make our units safer for staff and patients alike.
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