Effectiveness of environmental design interventions to reduce aggression and violence in emergency departments: a scoping review

Abstract

Aim: To investigate evidence for the effectiveness of physical design interventions to reduce patient and bystander violence in emergency departments. Background: Workplace violence in emergency departments can cause financial, emotional and physical harm for health care staff and organizations. Violence may be impacted by the physical design of the department. Method: A scoping review was undertaken of CINAHL, Medline, Scopus, and PsycINFO. The search utilized Boolean operators with key words, major search terms and subject headings. Inclusion criteria were physical design, violence and emergency departments. Studies on mental health or pediatric emergency departments, or non-research papers were excluded. AS review was used to sort and filter. Data was extracted into Covidence. Studies were reviewed for physical design elements used to manage aggression and outcomes. Content analysis of extracted data identified four themes. Results: Ten papers were identified. The majority of studies provided staff perceptions on the effectiveness of physical design on violence. Data revealed four main areas where physical design interventions could impact on violence from patients and bystanders. These were preventing harm from weapons, controlling physical access, observation and awareness and patient comfort. Conclusion: There is little evidence for the effectiveness of physical design interventions to reduce patient and bystander violence in hospital emergency departments. Despite a lack of empirical evidence, staff perceive that the physical design of the emergency department impacts on their safety. Further research is needed to better understand the effect of physical design on violence and determine which interventions are effective in impacting on aggressive behavior.