SOS - Save Our Staff: Designing a Safer Emergency Department
Amanda Henderson, RN, CEN, SANE-A, email@example.com; Faith Colen-Himes, MSN, RN, CEN
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Purpose: Emergency department staff voiced concerns of increased physical and verbal assaults by patients/visitors. Department design and security presence were not optimal. Staff felt ineffective in how to de-escalate situations.
Design: 22 month evidence based quality improvement project on increasing staff safety and satisfaction.
Setting: The setting for this project takes place in an urban level 3 emergency department that experiences 56,000 annual visits.
Participants: Participants in this project included nurses, physicians, patient care technicians, and secretaries in the emergency department.
Methods: Surveys were distributed to staff prior to initiating interventions in November 2011. The staff survey included a mixture of short answer and Likert Scale questions focusing on safety in the emergency department. The survey included perception of the hospital’s concern for staff safety and proper training to manage aggressive patients/visitors. The survey asked staff to report acts of violence and number of calls to security. In December 2011, 23 staff members voluntarily attended an 8 hour course on verbal de-escalation and escape techniques. In January 2012 initiation of a metal detector 24/7 at the entrance of the emergency department was installed. Security personnel were increased to operate the metal detector and respond to violent patients. Construction and renovation of the emergency department completed in February 2012. All entrances became badge access only, limiting access to emergency department staff and security. A 3 month follow up survey was conducted in March 2012 and June 2012. July 2012 three emergency department staff members attended a 40 hour training class on crisis management. Mandatory four hour training sessions for nurses, patient care technicians, and secretaries are scheduled to begin in August of 2012. Staff will attend the training yearly. Follow up surveys will continue every three months until August of 2013.
Results/Outcomes: The interventions taken to increase the safety of the staff in the emergency department significantly changed responses on the follow up surveys. Overall feelings of safety in the “Feel Completely Safe” (5/5) category increased from 8% to 19%, and decreased in the “Do not feel at all safe” (1/5) 23% to 0%. Over 8 months, staff reported a reduction in the following: verbal assault greater than 15 times in the past month-30%, being hit by a patient-14%, verbal intimidation-24%, and cursed at-31%. There was an increase of 41% in the feeling that staff safety was provided for. Staff reported an increase in security effectiveness of 37%. Monthly weapon counts yield approximately 350 weapons. Calls to security have been reduced by 50%.
Implications: Implementing a Violence Prevention Program increases staff satisfaction and safety by providing staff with the tools they need to create safety in the workplace.
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