Reducing violence and aggression in the emergency department (ED) – improving communication with patients Introduction and Aims Methods

Weight of workplace violence in ED: (1)

§ 72% verbal violence

§ 18% physical violence

§ >50% instigated by family members

§ 27% instigated by patients

North Middlesex Hospital(3)

§ >180,000 patients attend ED per year

§ Serves a population >90 nationalities

§ Deprivation is common; with 1 in 5 children living in poverty

§ Rising local rates of youth violence

Interventions suggested in previous QI project:

1) Information on current waiting times to be communicated to patients waiting in the ED

2) Artwork describing the triage process

3) Providing information in multiple languages

4) Structural adjustments to the main waiting area

5) Information on levels of violence and aggression toward NHS workers

Aims of our QIP:

Physical and mental impact of workplace violence on doctors and nurses: (2)

§ decreased job satisfaction (54%)

§ feeling scared (37%)

§ loss of sleep in (29% )

§ missing work due to violent incidences (6%)

All of the above can impact work productivity and patient care

What we have done:

§ Asked patients their perspectives on their experiences in ED

§ Involved nursing and reception staff in designing the information poster to ensure that adequate information is portrayed

1) To collect patient views on waiting times and understand the patient journey

2) To implement changes to the patient experience with a view to reducing the incidence of aggression towards staff in our department

3) Create a poster of the patient journey

4) Develop artwork with sixth form students

Results

1) 'Mentimeter’ questionnaire developed for patients in the ED waiting room

2) Sixth form students engaged to create posters about violence and aggression; we worked in partnership with a local state school with a high deprivation index with students of diverse backgrounds who wanted to become healthcare workers in the future

3) Stakeholders involved: patients, reception staff, students, security team, governance team, violence and aggression trust group

4) Translated the poster into different languages with help from our staff group

5) Posters displayed in the ED reception area

6) Live waiting time screen under development

Using the PDSA Cycle

• A framework for developing, testing and implementing changes leading to improvement

• The fishbone diagram identifies possible causes for an effect or problem

• These helped us to structure brainstorming sessions and sort ideas into useful categories

Lessons learned and next steps

§ We learnt that 2/3 of patients know where to find the updated ED waiting time

§ However, almost 50% of patients are not aware of which queue they are in and how long they will be in it

§ Clinicians need to better communicate this to their patients

We hope to:

1) Repeat the patient mentimeter questionnaire to compare results postintervention

2) Re-review statistics on violence and aggression after our changes have been implemented

3) Continue to engage with community representatives, security teams, trust violence and aggression group and local police