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 106.

    Took my father into A&E after he had seriously hurt his eye. When we arrived the estimated treatment time was 18 hours, by the time we gave up and went home to await a GP the time had increased to more than 30 hours.
    Little wonder people get annoyed. Esp when we know there are nurses sitting looking at party snaps at the nurses station instead of looking after people

  • rate this

    Comment number 105.

    Another problem is that you cannot mitigate for every situation.We have times when 30 patients arrive every hour for four hours.You cannot staff to be able to cope with that demand all the time, otherwise you are going to be in a situation with staff sitting around a lot of the time.There are patients in those numbers that may take several doctors and several nurses to treat them e.g. trauma.

  • rate this

    Comment number 104.

    I'm an ED doc in a large department.In terms of minor injury/illness, one of the things that I cannot square away,is that people are happy to book an appointment with their GP for later that day/next day,but when in the ED 4 hours is too long.The 4 hour wait is to register, triage, assessed and treated. 97% of the time, this is reached (for most hospitals).

  • rate this

    Comment number 103.


    For not much more than twenty quid they could buy a whiteboard and some dry wipe markers.

  • rate this

    Comment number 102.

    Why not try running A&E efficiently?

    It seems they'd rather spend money on a whizzy notice telling you why you are hanging around than on a nurse to treat you.

    My last college ran a massive enrolment each year with more people coming in than do to an A&E far more efficiently, and it wasn't something we did every day, just once a year but we did it right!

  • rate this

    Comment number 101.

    Those patients that have lived through two wars are generally appreciative and grateful, and are a joy to treat. There are also those that treat the NHS as the SERVICE that it has become. People are getting more and more impatient (no pun) as the pace of life increases. If you are well enough to complain about how long it takes to be seen, you are probably well enough NOT to be in A&E

  • rate this

    Comment number 100.

    Good ideas about improving A&Sorry to see so many posts criticising people for using A&E. Perhaps some people are not experiencing a serious accident or emergency but often it is hard to see GPs and certainly not over weekends or at night and people don't always know what consitutes an emergency.

  • rate this

    Comment number 99.

    As an A&E doctor, I think we could do better at keeping patients in the waiting room better informed. I have never been assaulted myself, but been on the receiving end of plenty of verbal abuse, and I'm sure lack of information doesn't help. I do however feel that some of the problems stem from people inappropriately using A&E / ambulances as a GP service (Eg attending A&E to get measured !)

  • rate this

    Comment number 98.

    another problem that could be addressed is the use of times and statistics - you are not even considered to be in A&E until you have been seen by a triage nurse.
    Several here have said you get seen right away if you turn up in an ambulance - not in my experience, my wife has been on the stretcher, with 2x paramedics awaiting admission for over 3 hours - the paramedics request for help was ignored

  • rate this

    Comment number 97.

    59 Minutes ago

    From my experience A&E attracts people that are at the fringe of society, drunks, foreigners & illegals and the numbers of these people are increasing.

    If your observation is to be taken seriously, you must spend a lot of time in A&E yourself. Assuming that you don't work there, to which of those 3 groups do you belong?

  • rate this

    Comment number 96.

    For that cost you could employ 2 extra staff for a year in each department and actually speed things up rather than just tell people why things are slow. And don't think that this system will not need maintenance and replacement, so you could probably keep an extra member of staff or two permanently in each department. Idiotic thinking by the hive public sector mind.

  • rate this

    Comment number 95.

    Surely economies of scale should allow this system to be put in place for less than £60k per hospital?

  • rate this

    Comment number 94.

    A few years ago I spent 4 hours waiting after a slight Dislocation to my left knee for some Tubigrip and a few Paracetamol, after I stated thanks for wasting 4 hours of my life I could of gone down to Boots and brought this myself, they then offered to give me an X-ray.


    and it seems you didn't actually need an X-ray. Sorry who is wasting people's time here?

  • rate this

    Comment number 93.

    As a former A&E nurse I know alot could be done but we do really get some time wasters in A&E. I've been shouted at by someone who waited 2 hours for minors - they had a paper cut. Plently of abuse from drunken people - even had to have a hand xray once due to a patients 'frustration'. And don't get me started on people who call ambulances because their out of paracetamol...

  • rate this

    Comment number 92.

    On the 2 occasions I have been taken to A&E in an ambulance I was seen and treated immediately.

    For less serious injuries it takes longer, as you would expect. They have to deal with life-threatening cases first.

    My GP is fairly rubbish - last time I asked for a home visit because I was too ill to get to the surgery I was told to call an ambulance.

  • rate this

    Comment number 91.

    1. Why does it cost so much just to keep patients informed. In the A&E at our local hospital there is one fairly large narrow screen that has a message scrolling round telling everyone roughly how long they will need to wait together with other information.

    2. Instead of spending all this money on coming up with ideas, why not spend it on an extra Nurse or two in A&E to ease the waiting times.

  • rate this

    Comment number 90.

    Isn't it about time we had a look at the real problem with our "beloved" NHS, a problem that can be verified by most people who have spent any amount of time in the company of it's much vaunted staff? A large proportion of the staff exude an I couldn't give a damn attitude, and a general demeaner for sloth, that is bound to wind patients up, drunk or sober.

  • rate this

    Comment number 89.

    Why A&E cannot attract consultants.

    From my experience A&E attracts people that are at the fringe of society, drunks, foreigners & illegals and the numbers of these people are increasing.

    A&E do a great job with difficult patients who are the product of a chaotic social mix.

  • rate this

    Comment number 88.

    @76 Without wishing to discuss your personal diagnosis, sub-acute small bowel obstruction secondary to Crohn's would not manifest as a three week pain but as a sudden onset of severe and crippling abdominal pain. If you were one of my patients I would save you a trip into hospital and see you direct with a gastro-enterologist on my ward. Shame you don't live near me eh ?

  • rate this

    Comment number 87.

    I have been in and out of A+E for the past 4 years with stomach/chest/back pain. I have never just wandered in, I always call NHS 24 first. I was told over and over it was heartburn. Only after a GP appointment I was sent up to hospital where I have gallstones. I now need an operation. Moral : call nhs24 first unless you are dying. No wait, just an appointment made.


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