Over the past year, the BEST (Behavior Emergency Support Team) team has become an indispensable part of the care environment at Atrium Health Carolinas Medical Center, providing critical behavioral health support in an increasingly complex and high-risk healthcare setting.

As workplace violence continues to rise, impacting one in four nurses during their careers, the BEST team has responded with compassion, expertise, and unwavering dedication.

The BEST team has been recognized specifically for their rapid response to help de-escalate behavioral health crisis, administer medication in behaviorally tense situations, and provide safe ethical restraint practices as a last resort to ensure patient and teammate safety.

The BEST team supports bedside nursing staff during stressful, unfamiliar behaviorally escalating situations that otherwise could be dangerous to the staff/patients if not managed with deliberate care.

What sets the BEST team apart is their therapeutic, team-centered approach. They work to collaborate seamlessly with the primary clinical staff to support not only their care delivery and learning, but also to foster a culture of empathy, safety, and healing for the patient. A perfect example of this collaboration and support occurred in labor and delivery. A code BEST was called to assist with a challenging situation evolving with a patient in labor. The mother had no prenatal care and appeared to be experiencing a behavioral health crisis. Because of the lack of prenatal care, the OB team was unfamiliar with the extent of the patient’s mental illness, and there was no plan of care to manage her effectively through this phase of delivery. When the BEST RN reached the room, the patient was obviously in much distress and in pain, and she had decided she was “done” – “not going to push” and unfortunately had become increasingly belligerent and combative with the staff who were only trying to help her and her baby through the laboring process. The BEST responding RN entered the room, presented with a woman completely disrobed, up on all fours in the middle of the bed, screaming and refusing to follow the primary care team’s directions. The BEST RN attempted to de-escalate verbally, but it was not going as well as it needed for her to be compliant with verbal directions. The maternity staff were concerned that the new mom would be facing an unplanned C-section if they could not coach her effectively and safely through the birthing process. The BEST RN collaborated quickly with the team to determine if medications might be applicable, and he worked to have the medications retrieved from an Omnicell outside of maternity, as this was not something this department stocked. Consulting with both the psychiatric and OB providers to ensure medications would be safe for the laboring mom and the baby, together they had a plan. Medications were given to help calm the patient’s severe agitation and anxiety and allowed her to be better coached through the birth of her child. In this case, the BEST RN used his expertise in mental health to partner with the maternity experts to safely deliver care to both mom and baby for the best outcome.

BEST’s presence has significantly reduced the emotional and physical toll on frontline caregivers, while improving outcomes for patients in distress. The team, led by the 6B RN responder, includes a multitude of clinical support personnel, including security services, spiritual care clinicians, nursing supervisors, nursing leadership, as well as the BH Consult Liaison and attending providers, as necessary.

BEST focused interventions have proven to prevent volatile scenarios from escalating into violent workplace events, directly contributing to improving patient care as well as teammate psychological safety.

From August 1, 2024, to July 23, 2025, the BEST team responded to six hundred behavioral health calls, dedicating over 365 hours to direct patient care and staff support. Their presence has helped de-escalate high-acuity situations, administer psychiatric medications safely, and implement ethical restraint practices when necessary. Notably, restraint utilization occurred in only 27% of calls, often involving patients already restrained prior to BEST intervention—demonstrating their commitment to least-restrictive, therapeutic approach.

The team’s efforts have directly contributed to a safer workplace, with only twenty-eight reported teammate injuries, representing a remarkably low injury rate of 0.04%. Their interventions have helped prevent unpredictable scenarios from escalating into violent events, protecting both patients and staff.
BEST’s reach spans across Atrium Health Carolinas Medical Center adult inpatient units, with calls originating from a wide range of departments, including:
• High-volume units such as 10T (63 calls), 3B (56), 10A (53), and 9B (49)
• Critical care areas like STICU (33), MICU (13), NSICU (7)
• Specialty departments such as Women’s Health (L&D – 17 calls)

The BEST team’s rounding RNs have worked hard to build relationships throughout the hospital, along with the multi-disciplinary team, to provide consistent, purposeful care for any patient in crisis. Their collaboration with a multidisciplinary team approach has elevated the standard of behavioral health care in the acute care setting and created a safer, more compassionate environment for all on this massive campus.

Additionally, the BEST initiative keeps evolving, and currently the RN rounders meet monthly to review specific cases, identifying wins and/or opportunities so that there is ongoing and continued learning among the responder group as well as actionable items to continuously improve the code BEST call processes.

The BEST team exemplifies the values of Advocate and Atrium Health—this is a group committed to Leading the Way, Thinking Boldly Together, Lifting Everyone Up, while Embracing the Unknown. Their work has transformed the behavioral health response model at Atrium Health Main and serves as a benchmark for integrated, mental health/behavioral health-informed care.