A&E redesigned to keep patients calm

Acoustic harmony and the psychological effects of lighting are not themes that are generally pondered by nurses and clinicians amid the life and death struggle of an Accident and Emergency department. Yet such subtle design influences might one day become a part of every A&E in the country, should the findings of a Department of Health study prove to reduce the incidence of assaults on NHS staff.

Working alongside the Design Council, the year-long research has focused on patient interactions with A&E staff in Chesterfield Royal Hospital, Guy’s and St Thomas’ Hospital and University Hospital Southampton to gain a better understanding of how frustrations with the A&E system can sometimes turn sane, calm people into foul-mouthed behemoths.

“We were particularly looking at low-level aggression as a route to trying to bring down overall aggression,” explains lead design consultant Tom Lloyd.

In the last year there were 57,830 physical assaults reported by NHS staff members. Of these 18,060 were categorised as non-medical, meaning they were prompted by the type of anger often associated with confusion and frustration.

The A&E prototypes being unveiled today aim to nip this in the bud through a series of simple measures such as introducing personal treatment maps to detail the process each individual is being led through. New signs will also explain why someone has seemingly jumped the queue because they’re in need of urgent attention, while information sheets will spell out why test results can take so torturously long to be completed.

The whole concept is designed to calm people’s fears and anxieties by showing the staff do care about their specific needs and are working methodically to resolve them.

“People never see what is going on in relation to ambulance patients that are being brought in from a different route. So maybe 30-40 minutes can pass with very little movement in the waiting room, and people naturally think ‘what’s going on here!’,” explains Ged Holland, security advisor at Chesterfield Royal.

To complement this the Design Council also want A&E staff to take command of their own environment by using statistics to predict when and where flare-ups are likely to occur, and handing them the means to adapt the environment to their advantage.

Chris Howroyd, programe manager at the Design Council, explains: “Consider you are a patient in A&E at two in the morning. You are obviously not very pleased because you are in A&E; there is a screaming child in the corner; and there is a full pitched light blaring into your eyes. Your stress levels are already quite high and the light is really not going to improve your mood or state of mind. So very simply handing the A&E receptionist or clinician the opportunity to dim those lights will have an impact.”

Howroyd also champions the benefits of organizing the layout of the A&E department so staff have more sight lines to see if something untoward is developing. The extra space will also enable patients to view the staff and remove any idea that that the nurses are just standing around gossiping.

“Most peoples experience of AE might just come from Casualty on TV, so they don’t know how to behave or what to expect,” adds Howroyd. “This brings it all out into the open.”

If this all sounds basic, then that’s because it is – the whole project has been designed to create the minimum of fuss to a nurses’ busy life.

Yet the big question is whether ideas created in a cosy design studio can actually work on the front line of a busy A&E department?

Certainly, the A&E staff involved in the research openly admit it won’t stop major incidents. Sally Wilson, A&E Matron at Chesterfield Royal, explains: “It won’t eradicate it all as there will always be people that are going to kick off no matter how you address them or what fittings you have in place. They are going to come in and they are going to kick off and we accept that.”

A&E specialist Dr Anthony Bleetman, agrees: “I think it will be very successful in dealing with the frustrations and mixed messages and poor information that often lead to aggression and violence. However, what it won’t do is deal with the very small minority of violent individuals who cause major problems.”

This recognition runs through every A&E department in the country and is partly responsible for the mass under-reporting of assaults by A&E staff. As Wilson puts it: “A&E nurses and doctors are quite robust and probably have a much higher fresh hold to other nurses – so we probably let things go that most would be offended by.”

Should you take a peek at the NHS stats on staff violence a curious pattern also emerges: around 68% of staff assaults occur in mental health wards, or are directed at NHS staff by mental health patients.

The Design Council ideas do not touch upon this. So while they may have an effect on A&E, their overall impact on staff assaults within the NHS is likely to be minimal. That is, unless the concept of using design is proven to work and adopted in the wider NHS. Its fate, therefore, would appear to rest on the next stage of the project: a test run being undertook at University Hospital Southampton.

“I think it will make a difference,” adds Ged Holland. “But whether it makes a radical difference we will just have to wait and see.”