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 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 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 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 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 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.


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