Implementing a re-structured response to behavioural disturbance in the emergency Department - A mixed methods...

Area of Science:

• Emergency Medicine
• Healthcare Management
• Patient Safety

Background:

• Rising global violence in Emergency Departments (EDs) necessitates improved management of behavioral emergencies.
• Early detection, de-escalation, and restraint are crucial for staff and patient safety.
• Previous research informed the development of a restructured approach by a multidisciplinary working party.

Purpose of the Study:

• To evaluate barriers and facilitators to implementing a new intervention for managing behavioral emergencies in EDs.
• To identify factors influencing the successful adoption of safety protocols.

Main Methods:

• Mixed methods study utilizing surveys and interviews.
• Application of the Theoretical Domains Framework (TDF) to analyze data.
• Involved 61 surveys and 12 interviews with nurses, physicians, and security staff.

Main Results:

• Identified six facilitators and nine barriers to implementing the Code Black intervention.
• Uncovered environmental, systemic, and cultural factors hindering implementation.
• Staff reported confidence in skills but some doubt behavioral change impact on safety.

Conclusions:

• The restructured approach effectively contains aggression, enhancing patient and staff safety.
• Implementation in complex ED settings is challenging, requiring further exploration for sustainability.
• The study provides evidence for identifying and overcoming barriers to implementing new practices in emergency care.