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

Authors Richardson SK, Ardagh MW, Morrison R, Grainger PC

Received 1 July 2019

Accepted for publication 29 August 2019

Published 12 November 2019 Volume 2019:11 Pages 271—290


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Hans-Christoph Pape

Sandra K Richardson,1,2 Michael W Ardagh,1,3 Russell Morrison,4 Paula C Grainger1

1Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand; 2Centre for Postgraduate Nursing Studies, University of Canterbury, Christchurch, New Zealand; 3Department of Surgery, University of Otago, Christchurch, New Zealand; 4Well-being Health and Safety Team, Canterbury District Health Board, Christchurch, New Zealand

Correspondence: Sandra K Richardson
Emergency Department, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8140, New Zealand
Tel +64 27 310 1675

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.

Keywords: aggressive patient, management of violence, emergency department, violence and aggression

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