Preventing violence and abuse: Insights from the Emergency Department
Supporting teams facing violence and abuse: Insights from the Emergency Department
My name is Dr Henry, and I am a Consultant in Emergency Medicine at the Royal London Hospital, where I lead the Emergency Department (ED) Violence and Abuse Working Group.
Violence and abuse are unfortunate realities in all emergency departments, and I’d like to share my experience in supporting teams that face these challenges regularly. I aim to offer practical insights for other managers who want to ensure the wellbeing of their staff in similarly high-pressure environments.
Violence and abuse have become daily occurrences in Emergency Medicine. Our department is a publicly accessible space, and we often care for individuals at higher risk of exhibiting violent or abusive behaviour. Overcrowding and the sheer volume of patients contribute to this issue. We’ve made a concerted effort to encourage staff to report every incident, no matter how minor. By gathering this information, we can better understand the extent of the problem and provide the necessary support to our teams.
Many people who visit our emergency department are stressed and anxious due to the unplanned nature of their visit. This can sometimes escalate into violence or abuse, especially if their needs are not met quickly.
Our patient population also includes those who are intoxicated, individuals with untreated mental health conditions, and people involved in violent incidents outside the hospital. Although we do everything we can to reassure and support these patients, it’s impossible to prevent all instances of abuse.
The impact of violence and abuse on staff can be significant. Everyone reacts differently depending on the nature of the incident and their own experiences. The effects of these incidents can accumulate over time, affecting not only individual performance but also the overall morale and mental health of the team.
As leaders, it’s important that we acknowledge the emotional toll these traumatic incidents take and offer tailored support to those affected.
I’m incredibly proud of the way our Emergency Department team leaders show compassion and care for their colleagues. We’ve made good use of our trust's 'recovery day', which allows staff paid time off after an abusive incident.
Additionally, we are extremely lucky to have our own in-house Clinical Psychologist, Dr Liz Harte, who provides one-to-one support for staff. Liz shares her expertise as a member of our Emergency Department Violence and Abuse working group, and also leads ‘Team Time’ sessions, providing an important safe group space for the team to process their experiences together.
I refer the team to a clearly designed flowchart that summarises the trust’s Violence and Abuse policy. In our emergency department, we also have specific policies for restraint, rapid tranquillisation, and mental health emergencies. Every week, we meet with the division to review incidents of violence and abuse, assess whether actions such as flags on patient records or exclusion from the hospital site are needed, and take further steps to safeguard our staff.
Training is an integral part of our approach. All staff are encouraged to attend Physical Intervention and Conflict Management training delivered by our security team. This training equips staff with key de-escalation techniques and intervention strategies.
We also host regular multidisciplinary teaching sessions, where our team, the security staff, and Dr Harte review particularly challenging cases. These sessions promote collaboration and ensure we learn from each other’s experiences.
In a recent incident, I was alerted to a team member who was upset after experiencing abuse in the waiting room. After listening to their account, I learned they had faced two consecutive incidents of abuse that morning. I offered immediate support and ensured there was no need for further action, such as involving the police.
I encouraged the staff member to report both incidents through our Datix system, as this helps us track the frequency and impact of abuse.
I offered the option of a recovery day to allow this staff member time to process the incidents and also took the opportunity to encourage them to sign up for physical intervention and conflict management training.
On reviewing the details of the incidents, I tried to understand potential triggers and drew up actions to aim to reduce recurrence. We have since worked with the Division and the security team to increase the presence of security within the waiting room. This has already made a noticeable difference.
Despite these challenges, what keeps me motivated in such a high-stress environment is the ability to bring order to chaos. There’s nothing more rewarding than seeing a stressful situation transform into a positive outcome for a patient or their family.
Emergency medicine is dynamic, fast-paced, and constantly challenging, and that’s what I love about it. It’s never a dull day.