Hospital trust in pioneering project to cut violence in emergency departments

Staff at Southampton’s teaching hospitals are leading a pioneering project to reduce violence and aggression in emergency departments, as a top doctor warns the problem is “getting worse”.

In a year-long study, run in conjunction with the Design Council and the Department of Health, doctors, nurses, receptionists and patients at Southampton General Hospital worked with design experts to identify the influences which cause tension and frustration and develop solutions.

By studying patient behaviour and interaction with staff, including incidents of aggression, the team, which also included psychologists and healthcare experts at two other UK hospitals, discovered the key to diffusing flare-ups lies within providing patients with a better understanding of the system.

They are now calling on hospitals to display relevant information at specific moments in the patient journey through the emergency department, where frustration and misunderstanding is likely to be worsened.

The ideas, to be unveiled at the Design Council headquarters in London today (Wednesday), are designed to be easily incorporated into older and modern hospitals, are low-cost and include a new approach to greeting patients on arrival, better signage, a ‘process map’ explaining the treatment process and screens to provide live information updates.

In addition, a toolkit for managers advises on the best ways to reduce the incidents through better department layouts, sight-lines, lighting, décor, seating and systems and procedures, while an induction pack for staff aims to quickly prepare new team members on ‘de-escalation’ techniques to diffuse potential problems.

Dr John Heyworth, a consultant in the emergency department at Southampton General Hospital and immediate past president of the College of Emergency Medicine, said: “Violence and aggression towards staff and other patients in the emergency department is a major nationwide issue – it has been getting worse and has not shown any signs of letting up in recent years.

“But, while there will always be a small minority intent on causing trouble, there are others who can resort to aggressive behaviour because they don’t feel they have been communicated with effectively, their privacy has been compromised through limited space and they don’t know what to expect from their treatment pathway.

“Better processes for meeting patients and discussing what they can expect, better training for both clinical and admin staff on how to handle volatile situations and improvements in the design of departments – some of which haven’t changed since the 1960s and 70s – can help to take the tension out and create a calmer environment."

Posted on Tuesday 26 March 2013