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.