Behavioral Escalation in the ED

Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members. 

Clinical Pathway:

• Behavioral Escalation in the ED Algorithm
• Behavioral Escalation in the ED Synopsis (provides care standards employed for this clinical pathway)

Additional tools associated with this Clinical Pathway:

• Management Based on Source of Behavioral Escalation

Inclusion criteria:

• Patients presenting or developing the following behaviors
  • Aggression - Change in body language, argumentative or defensive, verbal or physical escalation
  • Elopement - Verbal request to leave, movement towards exit, physical attempt to leave
  • Self-Harm Behavior - Expressed thought to harm self/others, present injurious behaviors or plan, intent during care
  • Threat to Harm Others - Expressed thought to harm others, present plan or intent during car

Exclusion Criteria:

• Any non-Children’s Mercy Kansas City patients
  • Including parents and family members

Team members involved in the development:

• John Graham, MD | Emergency Department | Committee Chair
• Dani Wentzel, DO | Developmental and Behavioral Health | Committee Chair
• Christopher Kennedy, MD | Emergency Department | Committee Member
• Brandi Missel, ARNP | Emergency Department | Committee Member
• Alec Bernstein, PhD, BCBA-D, LBA | Developmental and Behavioral Health | Committee Member
• Ibad Siddiqi, PharmD | Pharmacy | Committee Member
• Emily Snow, LMSW, MHSA | Developmental and Behavioral Health | Committee Member
• Philip Lawler, MBA, CPP | Security/Transportation | Committee Member
• Katie Stangler, MSN, APRN, CPNP, CCRN | Emergency and Trauma Services | Committee Member
• Tanis Stewart, MSN, RN, FNP-BC, CPN | Kansas Emergency Department | Committee Member
• Erin Bass, LCSW, LSCSW | Social Work | Committee Member
• Kathryn Worland, MSW, LCSW, LSCSW | Social Work | Committee Member
• Kourtney Frederes, RN | Emergency Department | Committee Member
• Holly Reid, RN | Emergency Department | Committee Member
• Michele Smith, CNA | Emergency Department | Committee Member
• Sarah Nienhaus, MSN, RN, CPEN | Emergency Department | Committee Member
• Viktoriya Stoycheva, MHA, BSN, RN, CPN | Emergency Department | Committee Member

EBP Committee Members

• Kathleen Berg, MD, FAAP | Hospitalist, Evidence Based Practice
• Jarrod Dusin, MS, RD, LD, CPHQ | Evidence Based Practice

Publication dates: 

• Finalized date: April 2025 
• Next expected revision date: 2028

If you have any questions regarding this content, or identify a broken link, please email evidencebasedpractice@cmh.edu. 

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.