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Principal Investigator: Ambrose H Wong
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $126,932
Funding agency: National Institute of Mental Health
PROJECT SUMMARY/ABSTRACT
This award is a four-year plan to support Ambrose Wong, MD, MSEd, an emergency physician, in his
transition towards an independent research career that focuses on dissemination and implementation of
services for mental health crises in general, non-psychiatric emergency settings. The long-term goal of his
research is to improve safety related to symptoms of agitation. To date, Dr. Wong's training has focused on
emergency medicine, qualitative methods, and education-based interventions. Under a team of co-mentors
with expertise in biostatistics, psychiatric services research, health informatics, and clinical trial implementation,
Dr. Wong will build on his preliminary work on agitation prevention and management to accomplish the
following training goals: (1) acquire expertise in clinical prediction modeling, (2) gain foundational knowledge in
preventing, treating, and investigating mental health crises, (3) study health informatics and development of
clinical support tools, and (4) obtain fundamental skills in clinical trials. The application integrates formal
coursework and training through mentored research activities.
Behavioral conditions in acute care settings are rapidly rising in the U.S., with a 50% increase in number of
general emergency department (ED) visits for mental health conditions over the past decade. Agitation,
defined as excessive psychomotor activity leading to violent behavior, is often part of these patient encounters.
Of the 1.7 million agitation episodes occurring annually in general EDs, 83% are associated with an underlying
serious mental illness. Given the safety risks of agitation, clinicians commonly use physical restraint, which are
associated with up to 37% risk of complications including traumatic injuries and even sudden death in patients.
Thus, regulatory bodies and experts emphasize early risk assessment and use of behavioral techniques before
agitation occurs. However, variability in practice and policy of these techniques exists in emergency settings.
This is due to lack of knowledge regarding specific risk factors that predict the need for pre-emptive
intervention and challenges in assessing these risk factors in the busy environment of an ED. The objective of
this project is to develop and test the Early Detection and Treatment to Reduce Events with Agitation Tool (ED-
TREAT), a clinical decision support system embedded in the electronic health record that will guide clinicians
in early risk assessment and appropriate treatment of mental health patients likely to develop agitation. We will
first derive a clinical model using health record data and preliminary analyses by our team that predicts which
at-risk patients will develop agitation and require use of physical restraint. Next, we will develop and refine ED-
TREAT through user-centered design techniques with clinicians and patients. Finally, we will conduct a pilot
trial to test the feasibility, fidelity, and bedside acceptability of ED-TREAT. Aligned with NIMH's strategic
priorities to use technology for improving mental health delivery in non-specialty settings, this study will form
the basis for a subsequent full-scale clinical trial to examine ED-TREAT's effect on clinical outcomes.
Terms: <Accident and Emergency department><Address><Aggression><Aggressive behavior><Agitation><Award><Behavioral><Biometrics><Biometry><Biostatistics><Characteristics><Clinical><Clinical Decision Support Systems><Clinical Trials><Collection><Complex><Data><Dissemination and Implementation><ED Physician><ED visit><ER physician><ER visit><Early Diagnosis><Early treatment><Education><Educational aspects><Electronic Health Record><Emergency Department><Emergency Department Physician><Emergency Medicine><Emergency Physician><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room><Emergency room physician><Emergency room visit><Enrollment><Ensure><Environment><Environmental Factor><Environmental Risk Factor><Event><Face><Goals><Harm Minimization><Harm Reduction><Health Informatics><Health Services Evaluation><Health Services Research><Health system><History><Institution><Intervention><Intervention Strategies><Interview><Investments><Knowledge><Laboratories><Lead><Medical><Medical Care Research><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Mental disorders><Mental health disorders><Mentors><Methods><Modeling><Modification><NIMH><National Institute of Mental Health><Outcome><Patient outcome><Patient risk><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pb element><Physical Immobilization><Physical Restraint><Policies><Predictive Factor><Prevention><Process><Provider><Psychiatric Disease><Psychiatric Disorder><Psychological Health><Psychomotor Agitation><Psychomotor Excitement><Psychomotor Hyperactivity><Psychomotor Restlessness><Public Health Informatics><Qualitative Methods><Randomized><Recommendation><Recording of previous events><Research><Research Activity><Research Resources><Resources><Restlessness><Risk><Risk Assessment><Risk Factors><Safety><Self Efficacy><Sudden Death><Symptoms><System><Techniques><Technology><Testing><Time><Training><Traumatic injury><Validation><Variant><Variation><Violence><Visit><Work><acute care><care delivery><career><chronic mental illness><clinical center><clinical decision support><clinical decision-making><clinical development><clinical predictive model><clinical research site><clinical site><clinical trial implementation><co-morbid><co-morbidity><cohort><comorbidity><consumer informatics><early detection><early therapy><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><emergency settings><enroll><environmental risk><faces><facial><feasibility testing><health record><heavy metal Pb><heavy metal lead><histories><implementation of clinical trials><improved><interventional strategy><mental health care><mental healthcare><mental illness><patient oriented outcomes><patient safety><persistent mental illness><pilot trial><preemptive intervention><prevent><preventing><psychiatric illness><psychological disorder><qualitative reasoning><randomisation><randomization><randomly assigned><rapid diagnosis><restraint><risk prediction algorithm><risk prediction model><risk stratification><sedative><serious mental disorder><serious mental illness><services research><severe mental disorder><severe mental illness><skills><stratify risk><support tools><tool><usability><user centered design><validations><violent><violent behavior>