The Code White protocol: a mixed somatic-psychiatric protocol for managing psychomotor agitation in the ED

Objectives: Clinical management of patients presenting with acute psycho­motor agitation is difficult, often because there is no predefined protocol for dealing with it. The main objective of this article is to describe our ­institution’s Code White mixed somatic-psychiatric protocol for managing acute agitation in an emergency department. Its second objective is to ­present data on how long it took to initiate and complete treatment. Methods: We retrospectively analysed 250 clinical situations over 3 years (2014–2016) from the hospital emergency department in the canton of Neuchâtel, Switzerland. Results: The median time from emergency department arrival to treatment initiation was 7 minutes; the median duration of treatment was 119 minutes. The rate of hospitalisation after emergency department treatment was 49.2%. Conclusion: This mixed somatic-psychiatric protocol seemed to reduce both the time before treatment initiation and treatment duration for ­patients presenting with acute psychomotor agitation in an emergency ­department. Implications for practice: The Code White protocol improved the emergency department’s ability to keep acutely agitated patients flowing smoothly and efficiently through it to other units or to discharge. On the qualitative level, it also improved staff safety and peace of mind, allowing them to carry out their many tasks more calmly