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

Type of content
Journal Article
Thesis discipline
Degree name
Informa UK Limited
Journal Title
Journal ISSN
Volume Title
Ardagh MW
Morrison R
Grainger PC
Richardson, Sandra

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.

Richardson 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.
aggressive patient, management of violence, emergency department, violence and aggression
Ngā upoko tukutuku/Māori subject headings
ANZSRC fields of research
1103 Clinical Sciences
Fields of Research::42 - Health sciences::4203 - Health services and systems::420306 - Health care administration
Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320207 - Emergency medicine
Fields of Research::42 - Health sciences::4203 - Health services and systems::420309 - Health management
Fields of Research::35 - Commerce, management, tourism and services::3505 - Human resources and industrial relations::350505 - Occupational and workplace health and safety
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