Aggressionsmanagement im Universitären Notfallzentrum Inselspital Bern

Introduction: Aggression against healthcare workers is increasing worldwide. ED and psychiatric clinics are hotspots for external and self-aggression. Upon conducting a literature review, it was found that there are currently no evidence-based measures for the management of aggression, and cooperation with partner organizations. This work should close the gap in current knowledge and provide new insights.
Methods/Aims: In our study, we examined the objective safety and the nursing staff’s perception of safety at our University ED. Additionally; we examined 33 ward managers and partner organizations regarding the safety measures in place. For this purpose, we conducted quantitative written surveys and interviews on patients, staff and seven experts of partner organizations1. These surveys and interviews were descriptive and analyzed qualitatively.
Results: Within 3 months, 97% and 45% of all examined staff experienced verbal and physical attacks. Additionally, 81% of staff perceived an improvement in safety after specific interventions. Furthermore, 57% of staff declared that the size of the team had a significant influence on the perception of safety. In contrast, the influence of seniors was perceived as low. Lack of leader function and insufficient sedation were the two points most criticized in case of implementation of the five-point fixation. Interdisciplinary training among doctors, nursing staff and security personnel should be carried out on a regular basis to improve collaboration in such critical cases. The creation of a waiting area (with stress reducing elements) in which patients are comfortable, led to a greater acceptance of the waiting times. Large ED, such as ours, experience absolutely and relatively more cases of aggression, however many experts believe that the University ED may not be the best place to manage an aggressive patient.
Conclusion: Our research has developed a new understanding of security measures, and interdisciplinary interventions and cooperation, which includes the perception of security by partner organizations. Interprofessional and interdisciplinary training courses strengthened staff response and improved security. Additionally, we showed that there is relevant potential for optimization by introducing new security personnel additionally to promoting cooperation between security services, nursing staff and doctors.