Challenging the culture of Emergency Department violence and aggression.

AIMS: To examine reported levels of violence and aggression within a tertiary level emergency department in New Zealand, and to compare incident reporting within a dedicated yearly audit period to standard organisational reporting procedures. METHOD: A prospective, longitudinal cohort study involving repeated yearly audits of violence and aggression reported by emergency department staff from 2014-2020. RESULTS: Episodes of violence and aggression were reported at high levels during audit months compared to standard reporting, suggesting current systems do not accurately reflect the presence of violence and aggression. Levels of reported violence and aggression remained relatively static over a seven-year period, despite increasing emergency department attendances. Most events reported involved verbal abuse from patients, and occurred on weekend and night shifts. A number of potentially contributing factors were identified. CONCLUSIONS: Persistently higher levels of violence and aggression were reported during the targeted audit months, while reporting via the organisation's formal system during the intervening months remained at low levels. Further research is essential to monitor trends, assess the effectiveness of interventions to improve reporting, modify factors contributing to violence and aggression, and to address the impact on staff and bystanders affected in emergency departments.

Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base.

INTRODUCTION: Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same. AIM: To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient. METHODS: A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice. RESULTS: An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested. CLINICAL IMPLICATIONS: The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice. CONCLUSION: There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified.

Violence and aggression in the emergency department is under-reported and under-appreciated.

AIM: To examine levels of reporting of violence and aggression within a tertiary level emergency department in New Zealand, and to explore staff attitudes to violence and reporting. METHOD: A one-month intensive, prospective audit of the emergency department's violence and aggression reporting was undertaken and compared with previously reported data. RESULTS: There was a significant mismatch between the number of events identified during the campaign month and previously reported instances of violence and aggression. The findings identified that failure to report acts of violence was common. CONCLUSIONS: Reports of violence and aggression in the emergency department underestimate the true incidence. Failure to report has potential impacts on organisational recognition of risk and the ability to develop appropriate policy responses.