Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department
Abstract
INTRODUCTION
A Code Black is the coordinated response by healthcare staff and security to an act or threat of verbal and physical aggression or violence perpetrated by a patient, family member or visitor towards healthcare staff within a hospital setting. Behavioural disturbance is often verbally de-escalated by staff. However, as a last resort physical and/or chemical restraint may be necessary. Reports show that there is an increasing number of violent incidents in Emergency Departments (ED), emphasising the importance of staff training for Code Black events. This research examines the response of healthcare staff to aggression and violence in the ED, the supporting structures that manage a Code Black event and potential avenues for restructuring the response.
METHODS
We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed.
RESULTS
Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for…
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