Improving Safety in the Emergency Department Through De-escalation Training

Violence toward emergency care providers is common, with both patients and staff sustaining injuries (Hamdan & Hamra, 2015). Significant financial and personnel costs follow a violent incident, including damage to the facility and injuries resulting in medical care and lost time on the job for recovery. After an assault, health care providers intentionally avoid engaging with patients who have violent tendencies, leading to a delay in or disregard of their medical care (Pompeii et al., 2015). Violence towards emergency workers is well documented, and there is no universal approach to addressing the violence. Multiple factors lead to violence in the emergency department (ED). Emergency providers frequently encounter intoxicated, psychotic, and angry patients who feel their needs are unmet. Emergency care providers' awareness, comfort, and experience working with violent psychiatric patients in the emergency department were assessed using a validated survey, the Management of Aggressive and Violence Attitude Scale (MAVAS). The MAVAS questionnaire measures perceived personal safety and staff attitudes toward aggressive and violent patients. Participants who engaged in the brief de-escalation education intervention failed to demonstrate a statistically significant increase in their perception of personal safety and/or attitude towards agitated patients. Overall scores improved in terms of situational/interactional and management factors, which indicates that staff attitudes improved regarding the care and management of agitated patients. All participants indicated they would like to receive additional training in dealing with agitated people. Providing brief de-escalation presentations alone to health care workers is insufficient to improve their perception of personal safety and attitudes when dealing with agitated patients. However, a positive trend in situational/interactional and management factors suggests staff attitude improvement in caring for and managing agitated patients following additional de-escalation education.