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Call to redesign A&Es to cut violence risk


Accident and emergency departments could be redesigned to significantly reduce violence and aggression towards staff for as little as £60,000, a Department of Health commissioned study suggests.

Researchers from the Design Council spent about 300 hours observing A&E departments and identifying the triggers for threatening behaviour, estimated to cost the NHS £69m a year in reduced staff productivity and insurance costs.

Design Council chief design officer Mat Hunter said “otherwise calm and rational people”, as opposed to mentally ill patients or addicts, got “frustrated” because they did not understand the system.

Working with Guy’s and St Thomas’ Foundation Trust, University Hospital Southampton Foundation Trust and Chesterfield Royal Hospital Foundation Trust, the Design Council has developed a three pronged approach to driving improvements focusing on patient information, staff engagement and the development of a toolkit for managers making decisions about redesigning A&E.

The toolkit aims to provide insight into what drives aggressive behaviour and offer suggestions for simple improvements to aspects of departments including lighting, layout and comfort.

“Something as simple as getting a cup of water can cause problems so a simple thing like having a free drinking water machine that patients can get to makes a difference,” Mr Hunter said.

“If you improve people’s experience of A&E you will improve behaviour.”

The Design Council estimates most emergency departments can be improvements through retrofittings for about £60,000.

To improve patient information, receptionists are encouraged to explain to patients what they can expect on arrival while location specific signs are placed at relevant places throughout the patient’s journey around the department to keep them informed.

The Design Council has developed a flow diagram patients can use to see how they will move through the system and the differing pathways for major and minor injuries. Researchers also suggest an electronic display can be linked to the department’s computer system to keep patients informed about how busy it is. They are often unaware of things going on behind the scenes, such as the arrival of patients by ambulance, that contributes to their wait.

Click here to see the research and online toolkit visit


Readers' comments (6)

  • Good idea. It's long been recognised that people can be affected by their environment just as much as the other way round.

    Probably the most important part of this though is the commitment to improve communication- not something the NHS particularly excels at.

    People are generally understanding if they're treated like adults and told what's going on

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  • Geeze | 16-Nov-2011 2:03 pm

    'People are generally understanding if they're treated like adults and told what's going on'

    Unless they are out of their faces on alcohol and drugs, as rather too many of those who pass through the doors of our ED, are.

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  • michael stone

    It is a good idea - and, it might happen, because it fits in with this goverment's liking for 'nudge theory'.

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  • It would also be nice to work in a department which hasn't got blood splattered walls - caused mainly by the staff banging their own heads off it in desperation! Maybe Estates could paint a bullseye target on just one wall for staff use only.

    Also, just for the record, no water coolers in patient areas until the public can manage not to spill the stuff for little old ladies to slip on.
    Some more parking spaces might help as well - lack of parking and the cost of it is the main bone of contention in my place of work.

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  • Psycho-acoustics is also a consideration in managing environmental factors. Ambient noise levels may not be distressing to staff who work in a hospital environment every daily. However, clients, including clients in pain, may be sensitive to this and act irrationally when subjected to it for what is perceived as an indeterminate period of time.

    Staff training and education on managing behaviours of concern is also very important, including communication and conflict resolution strategies, and how to manage and de-escalate transference from clients.

    I fully agree with the previous comments about communicating with the clients about wait times, anticipated outcomes and allow them to express their feelings in a safe environment. Preventing counter-transference when confronted with an angry client is a skill that can be learned from mentors and role models with experience in de-escalating aggressive behaviour.

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  • i just wonder how much the goverment paid out for this research, most of which is already know to all the nurses? (a little more headbanging?? what you think @ Anonymous | 19-Nov-2011 4:38 pm)

    AND did they get in the way of the day to day running of the A&E ?

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