A Better A&E

Client: Department of Health Design Council

Sector: Healthcare

Commission: 2011

Launch: 2012

A multidisciplinary team, led by PearsonLloyd, created a three-pronged set of design solutions that have been proven to reduce levels of violence and aggression in Accident & Emergency (A&E) departments.

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Rigorous evaluations at pilot trusts in London and Southampton found the solutions improved patients’ experiences of A&E, reduced levels of frustration and potential hostility, whilst also delivering cost savings. Both patients and staff observed significant reductions in aggressive behaviour, with a 50% fall in incidents. There were also associated improvements in staff morale, retention and wellbeing, with stress related staff absences falling significantly after the implementation of the solutions.

The project began from research outlining that one in ten NHS staff experiences violence at the hands of patients or their relatives each year. This problem is particularly prevalent in A&E departments, and costs the service an estimated £69m per year. Recognising that poor patient experience was a key driver of incidents of violence and aggression, the intention of the design solutions was to improve patient experience, support frontline staff and provide design recommendations.

The Guidance Solution informs and guides patients through their time in the department using signage, leaflets and digital platforms. Each element communicates essential information to patients, including how the A&E department works, and live updates on personal waiting times. It is an information package – designed to be implemented throughout any A&E department – that greets patients on arrival, answering their questions and ensuring they start the A&E experience positively.

The People Solution works with old and new frontline staff to ensure the necessary support and facilities are available to understand, learn about and improve ways of handling violence and aggression, while maintaining high levels of compassion and empathy. This is achieved through communications training and reflective practice.

Presented as a set of guidelines, the Toolkit offers a number of high level design recommendations, which are focused more on the built environment or service changes. It is aimed at NHS managers, clinicians and healthcare planners and is a free download found online.

The solutions were trialled at two sites for the evaluation study, and have been implemented at a number of other trusts since. Further information on the project and implementing the solutions can be found at www.ABetterAandE.com.