AUTHOR BIOGRAPHIES
Matthew A. Taylor, PhD, Patient Safety Authority
Matthew A. Taylor (MattTaylor@pa.gov) is a patient safety analyst for the Patient Safety Authority (PSA), where he conducts research, uses data to identify patient safety concerns and trends, and develops solutions to prevent recurrence. He is a core team member of PSA’s Center of Excellence for Improving Diagnosis. Prior to joining the PSA, Taylor was a scientific writer and research specialist at the University of Pittsburgh School of Pharmacy, and he has served fellowships at the Centers for Disease Control and Prevention (CDC) and the VA Pittsburgh Healthcare System. His expertise in data analysis and research covers a range of topics, including patient safety, public health, employee training, process efficiency, human factors, workplace culture/climate, behavior change interventions, and organizational management.
William Pileggi, MSN, CRNA, MAJ, USAR/AN (Ret.), VA Pittsburgh Healthcare System
William Pileggi (William.Pileggi@va.gov) is a certified registered nurse anesthetist for the VA Pittsburgh Healthcare System’s (VAPHS) Department of Anesthesiology. He is the lead anesthesia team instructor for VAPHS’s PTSD/Emergence Delirium Safety Training and Response Team, collaborating with physician anesthesiologists in anesthesia care and delivery. In this role, he teaches perioperative staff how to better identify and assess those veterans most at risk for emergence delirium and co-instructs anesthesia personnel on medication choice and strategy to prevent and/or treat emergence delirium. Pileggi has worked in healthcare since joining the Army in 1984. He is a retired 26-year Army Reserve major, Nurse Corps officer, which includes five years as an enlisted operating room technician (sergeant). Pileggi also had 20 years of practice at the University of Pittsburgh Medical Center.
Michael Boland, MSEd, VA Pittsburgh Healthcare System
Michael Boland is a training specialist for the Department of Veterans Affairs, VA Pittsburgh Healthcare System (VAPHS). Working within the Department of Education and Innovative Learning, he is responsible for providing staff education and training regarding behavioral emergency response, crisis prevention and intervention, team training, and verbal de-escalation, as well as psychological first aid and resiliency training. For the past 10 years he has served as a volunteer member of the VAPHS behavioral emergency response team and currently provides stress management support and education for employees following traumatic situations. Prior to working for VAPHS, he worked as a clinical educator for University of Pittsburgh Medical Center Western Psychiatric Hospital.
Monique Y. Boudreaux-Kelly, PhD, VA Pittsburgh Healthcare System
Monique Y. Boudreaux-Kelly is an epidemiologist and biostatistician with the VA Pittsburgh Healthcare System’s (VAPHS) Department of Research. She is the head statistician with VAPHS’s Research Office StatCore. In this position, she advises on study design and statistical methods; conducts statistical analysis; and contributes to presentation materials and manuscripts for research, clinical, and administrative projects for local and national VA facilities. Boudreaux-Kelly has held this position since 2011 and prior to this position she worked for a contract research organization as a medical writer and completed a postdoctoral position at the University of Pittsburgh Medical Center Western Psychiatric Hospital.
David V. Julian, MEd, VA Pittsburgh Healthcare System; University of Pittsburgh Medical Center Altoona
David V. Julian is the designated learning officer for the VA Pittsburgh Healthcare System’s (VAPHS) Department of Education and Innovative Learning. With experience in behavioral health and simulation education, he is a team instructor for VAPHS’s PTSD/Emergence Delirium Safety Training and Response Team. In this role he teaches prevention and de-escalation techniques specifically related to veterans at risk for emergence delirium. Prior to coming to the VAPHS in 2010, Julian was the program coordinator at the University of Pittsburgh Healthcare System’s Crisis Training Institute. Throughout his career, he has designed and facilitated a variety of courses related to crisis prevention and trauma response.
Amanda K. Beckstead, DNP, CRNA‡, University of Pittsburgh Medical Center Altoona
Amanda Beckstead received her doctor of nursing practice in nurse anesthesia at the University of Pittsburgh (Pitt) in 2020. Her doctoral capstone dissertation, “Implementation of a Medication Administration Didactic Session and Protocol to Effect Provider Willingness to Utilize Best Anesthetic Practices for Patients With Post-Traumatic Stress Disorder Undergoing Surgery,” was completed at the VA Pittsburgh Healthcare System. She received the Pennsylvania Association of Nurse Anesthetists’ 2020 Outstanding Student of the Year Award. She completed three years of CCRN practice at the University of Pittsburgh Medical Center (UPMC) Presbyterian Medical intensive care unit before returning to Pitt for her graduate research and nurse anesthesia doctor of nursing practice studies. Beckstead currently practices full-time at the UPMC Altoona medical center.
Abstract
Emergence delirium (ED) is a temporary condition associated with a patient awakening from an anesthetic and/or adjunct agent (e.g., sedatives and analgesics). During the condition, patients risk harming themselves or staff by engaging in dangerous behavior, which may include thrashing, kicking, punching, and attempting to exit the bed/table.
A multidisciplinary team at Veterans Affairs Pittsburgh Healthcare System (VAPHS) developed and implemented a multicomponent intervention to reduce the severity and occurrence of ED. The intervention consists of a training component and 21 clinical components. The 21 clinical components are implemented on a patient-by-patient basis and include routine screening for risk factors, enhanced communication among staff, adjusting the environment, following a specific medication strategy, and application of manual restraint (hands-on). The authors provide 15 online Supplemental Materials (S1–S15) to promote replication of the intervention.
To our knowledge, this is the first manuscript that describes this type of multicomponent intervention in sufficient detail to allow others to replicate it. Following implementation of the intervention at VAPHS, perioperative staff reported that they observed a substantial reduction in the occurrence and severity of ED, ED-related patient and staff injuries, and ED-related loss of intravenous access and airway patency. Despite staff’s reported success of the intervention, rigorous research is needed to evaluate the efficacy of the intervention.
