Designers try to stop patients abusing casualty staff


How one emergency department could be improved by the new design

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Designers have come up with ideas to try to stop patients losing their temper with staff at accident and emergency (A&E) departments.

The year-long project explores how the NHS can use cheap solutions to ease patients' frustration.

Busy emergency department The emergency department at Southampton General sees 300 patients a day.

Psychologists helped identify why people who are normally calm might flare up in casualty departments.

The Department of Health commissioned the work to find out how the units could become calmer.

Figures published last week revealed there were 57,830 physical assaults on NHS staff in England in 2010-11, a rise on the previous year.

Start Quote

Violence and aggression towards staff and other patients in the emergency department is a major nationwide issue.”

End Quote Dr John Heyworth Southampton General Hospital

The Design Council briefed experts to find simple solutions that would make A&E patients feel less alienated, and help them understand why they might be having to wait.

The psychologists helped the designers identify six profiles explaining why patients might become violent (such as being drunk or confused), and nine factors that could trigger violence - such as inhospitable environments.

Solutions include a new approach to greeting patients when they arrive and answering their questions, as well as clearer signs and maps explaining the different stages of A&E treatment.

Another suggestion is to use screens to give live updates about how many cases are being handled by the staff at that time.

There is also specific advice about lighting, decor and seating for managers who are planning major refurbishments.

It's now expected that three hospitals in Chesterfield, Southampton and London will test the ideas.

The head of the Design Council, David Kester, said: "This is design at its best - solving a long-standing, high-cost problem through creativity, simplicity and collaboration.

"For not much more than £60,000 hospitals can now quickly and easily install this system which could significantly reduce the burden of aggression from patients."

Practical solutions

Attacks on NHS staff are thought to cost at least £69m a year through victims needing time off work and legal costs in pursuing cases.

The health minister, Simon Burns, said: "Despite an increase in the sanctions taken against people who assault NHS staff, more needs to be done - and we are taking action.

"These are practical solutions - and are ways in which hospitals can easily redesign the environment according to their budget.

"Difficult situations can be diffused by simply giving patients more information."

A consultant in the emergency department at Southampton General Hospital, Dr John Heyworth, said: "Violence and aggression towards staff and other patients in the emergency department is a major nationwide issue.

"It has been getting worse and has not shown any signs of letting up in recent years.

"While there will always be a small minority intent on causing trouble, there are others who can resort to aggressive behaviour because they don't feel they have been communicated with effectively and they don't know what to expect.

"Some emergency departments haven't changed since the 1960s and 70s. Improvements in the design can help to take the tension out and create a calmer environment."


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  • rate this

    Comment number 66.

    Typical of NHS waste all round.

    A good system but massively over priced at £60k a go.

    Plus the NHS spends £69m in legal fees chasing attackers through the courts - why isn't this a criminal activity that the police manage?

    There probably lies the problem - no one gets punished for attacking NHS staff, so now it's more common. It should be a mandetory prison sentance though.

  • rate this

    Comment number 65.

    Is everyone missing the point? ACCIDENT and EMERGENCY? Last time I was there after breaking my finger there was a woman who 'had a sore throat' and another man who 'Had a tummy upset'. No wonder we have such huge waiting times. If people went to their chemist, doctor or the online NHS point and stopped rocking up at A&E for this type of thing we would half the problem.

  • rate this

    Comment number 64.

    Triage, triage, triage.
    A triage nurse should see you within 5 minutes and give an assessment including the ability to say "Go home and see your GP in 5 days if it's not cleared up". Apparently they cannot tell you to go home because you're "booked in" and have to be discharged by a doctor.

  • rate this

    Comment number 63.

    There can be no excuse for assaulting A&E staff.Those that do should be prosecuted to the full extent of the law and made to pay in jail.That means prosecutions must be done in every case to act as a deterrent.

  • rate this

    Comment number 62.

    I always remember taking a girlfriend suffering from a bad asthma attack into A&E, despite that fact that I'd practically carried her in from the car, whilst I was basically holding her up the receptionist was just going through the motions, it was only when she went grey and passed out on me that they actually suddenly took a real interest.

    Mr Jobsworth has no place in A&E.

  • rate this

    Comment number 61.

    Occasionally, non-aggressive frustration is justified.

    At 18 months old, our daughter suffered a head injury at a time when A+E was not busy. They made her wait 30 minutes just to see triage! She only became responsive to visual/ verbal contact 5 minutes before triage. The triage nurse wrote "responsive in A+E" on her medical notes!

    We contacted "PALS" and they fixed the problem locally.

  • rate this

    Comment number 60.

    We recently spent four hours sitting in A&E with my 10-yr old, waiting to be seen. The reason? They had several patients in recussitation, needing all staff to be on hand. I only knew this because I knew one of the nurses and she told us when when she brought painkillers for my DD. An update board such as the one in the article would really help. The staff work hard - just keep us informed!

  • rate this

    Comment number 59.

    As a former customer care manager, I know that the most effective way to prevent customers (which is what patients are) from becoming angry is to keep them well informed and manage their expectations. Most people are reasonable and don't mind waiting if they know how long it's going to be and why that is the case. Communication is a major area for improvement throughout the NHS.

  • rate this

    Comment number 58.

    Education as to what your GP and a GP surgery that is open at the weekend would help to stop people going to A&E with "trivial" problems. I have spent this last weekend worrying about my health but concerned that the problem I had wasn't an A&E type problem. If my surgery had been open I could have got the problem sorted quicker - I'm still waiting.

  • rate this

    Comment number 57.

    I agree that many people who assault staff might do it anyway, but if spending £60,000 makes assaults less likely and prevents one assault a year then it'd probably save money. It's also good for the rest of us to have the information!

  • rate this

    Comment number 56.

    @20 The idea that "self inflicted" injury's should be refused treatment shows considerable ignorance. Drug / alcohol abuse is often a symptom of mental health problems, and that is not something ANYONE chooses.

    Should the NHS also stop treating heart patients who eat fatty foods, builders who have severed a finger,executives with stress etc.
    We all pay in, we all get treatment. That's the point.

  • rate this

    Comment number 55.

    Any 'patient' abusing A&E staff should be refused treatment and be told to find a private practice instead unless their condition is life threatening. Nurses and doctors should not be subjected to abuse. As for those who physically assault NHS staff - frankly nothing less than a lifetime ban from using the NHS would be acceptable.

  • rate this

    Comment number 54.

    The biggest issue is that when you are sat in the waiting room you do not see the more sick or injured people being brought in behind the scenes. Having some information available that lets them know that the staff are busy saving a life would make most people think twice about being impatient about a more minor problem.

  • rate this

    Comment number 53.

    I work at a local hospital in a rural area. GPs in the surrounding areas, up to 25 miles away, advise people to come to A&E if they can't get a GP appointment within a couple of days. The A&E workload more than doubled within a short time of the changes to the GP contract.

  • rate this

    Comment number 52.

    @35 And_here_we_go_again

    Treat a dislocation with a bandage and paracetemol? Really? No concern for nerve damage, restriction of blood flow or bone chips floating around? wating until a GP can see you just wouldn't cut it.

    That said I do agree that keeping patients informed of the number of A&E patients and types of injuries being treated would be very helpful in reducing frustrations.

  • rate this

    Comment number 51.

    It doesn't need much expense to solve the problem. My experience of A&E is that the reception staff are very curt and reluctant to give any information. Expectations are not set. If I am told at the outset that there is about a 3 hour wait I can manage the situation but if I get to a near empty A&E department and I see staff have personal converstations I assume that I might be seen quicker

  • rate this

    Comment number 50.

    How many people realise how few doctors there are in hospitals at night? I work in a teaching hospital and at night we work 12.5 hour shifts with two doctors covering the ALL the acute medical wards. Last night I was bleeped once every 10 minutes and had no break for a drink, food or even to go to the loo. People need to realise how much effort is put in on their behalf and be grateful.

  • rate this

    Comment number 49.

    Recent experience of a W London A&E was the difficulty getting out of A&E. The treatment had been done, but we were stuck there for hours while a spare ward bed was hunted down. When we got to the ward there were loads of beds and loads of room to wait. You would have thought that busy A&E staff would want to get the closed cases off their patch as quickly as poss.

  • rate this

    Comment number 48.

    So many people have no idea what an A and E unit does and how it works. Patients are seen in order of need, and while your broken wrist may be painful, you are unlikely to die. Unlike the 80 year old with pneumonia. There are more suitable alternatives to A and E, and often you will seen more quickly for your minor complaint at either your GP, walk-in-centre or minor injuries unit

  • rate this

    Comment number 47.

    From a family member who was an A&E doctor, many people seem to use A&E instead of signing up for a GP. No wonder they are overwhelmed. The trouble is that they can't turn people away


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