Management of the aggressive emergency department patient: Non-pharmacological perspectives and evidence base (2019)
Type of ContentJournal Article
PublisherInforma UK Limited
- Health: Journal Articles 
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.
CitationRichardson SK, Ardagh MW, Morrison R, Grainger PC (2019). Management of the aggressive emergency department patient: Non-pharmacological perspectives and evidence base. Open Access Emergency Medicine. 11. 271-290.
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Keywordsaggressive patient; management of violence; emergency department; violence and aggression
ANZSRC Fields of Research42 - Health sciences::4203 - Health services and systems::420306 - Health care administration
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320207 - Emergency medicine
42 - Health sciences::4203 - Health services and systems::420309 - Health management
35 - Commerce, management, tourism and services::3505 - Human resources and industrial relations::350505 - Occupational and workplace health and safety
RightsAll rights reserved unless otherwise stated
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