Violence in the ED is on the rise. The urgency to create safer healthcare environments, particularly in emergency departments (EDs), is now more critical than ever. Recognized as the front line of healthcare, the ED faces an escalating threat of violence that jeopardizes the safety and well-being of its staff. Recent incidents, including attacks on medical facilities, highlight the pressing need to address safety concerns. In this article, I explore five key design solutions aimed at creating a more secure environment for front-line ED workers who increasingly find themselves in the middle of their own emergency situations— often life-threatening and requiring immediate assistance.
Understanding the Problem
Data from the U.S. Bureau of Labor Statistics reveals that workers in healthcare and social service sectors are five times more likely to be injured as compared to their counterparts in other industries. The majority of violent incidents stem from patients’ family members or friends, closely followed by the patients themselves. According to the World Health Organization’s 2022 report, healthcare professionals at the greatest risk are those stationed at emergency departments, especially nurses and paramedics, along with staff directly involved with inpatient care.
Numerous research studies have established a direct correlation between the percentage of patients awaiting care and the incidence of physical violence against nurses. Uncomfortable environments, such as confined spaces, overcrowded corridors, excessive heat or noise, and even unpleasant odors, have all been identified as potential triggers for aggression displayed by visitors toward healthcare providers. A nationwide survey conducted by National Nurses United (NNU) in April 2022, involving more than 2,500 registered nurses, brought forth alarming results—48% of nurses reported experiencing workplace violence. This represents a surge of 30.6% since September 2020.
Recognizing the urgent need to enhance safety in the emergency department, the following outlines five key design solutions that mitigate the risk of violence and prioritize the safety of staff:
- Layered Perimeter Design: This involves strategically planning security measures for an ED, incorporating multiple layers to address potential safety breaches at various points, such as the ED’s building perimeter, entry and exit points, vestibules, the interior lobby and other internal zones. Establishing a robust defense against potential threats can begin with traffic-calming measures and extend to physical barriers like bollards, ballistic panels, and controlled access points throughout the facility.
- Physical Layout and Visibility: A well-thought-out physical layout can play a crucial role in preventing violence. Open and visible layouts, allowing staff to easily monitor different areas, reduce the risk of hidden confrontations. Clear sight lines, strategically placed security cameras, and glass petitions can also enhance visibility while maintaining a sense of openness.
- De-escalation Spaces: Designing dedicated de-escalation spaces within the ED allows staff to address agitated or aggressive individuals away from the main patient areas. These spaces should be equipped with comfortable seating, calming colors, and resources to help staff manage challenging situations effectively.
- Security Measures: Incorporating effective security measures into the design is imperative for safeguarding the ED. For example, installing metal detectors that can deter potential threats. Additionally, panic buttons and communication systems should be readily available to staff, enabling them to call for assistance swiftly in the case of emergencies.
- Departmental Escape: Delineating a well-defined and easily accessible escape route for staff within the layered perimeter design is also a critical aspect of safety and security in the ED. This designated pathway serves as a means for staff to evacuate quickly and efficiently in the event of an emergency situation, such as a threat or crisis scenario.
Serving Their Intended Purpose
In the pursuit of safer emergency departments, the significance of innovative design solutions cannot be overstated. It's important to note, however, that creating a safer ED environment goes beyond the physical building and its design—it requires a holistic approach involving law enforcement, security staff, clinical personnel, nursing teams and operational staff. The success of such a strategy relies on the meticulous implementation of protocols and regular training to foster a shared understanding of appropriate responses, reducing panic-inducing situations. Coupled with the integration of technology—which is pivotal in addressing security gaps that cannot be solely managed by staff—this multidimensional approach has the potential to transform emergency departments into what they were intended to be—safe havens for healthcare professionals and those seeking urgent medical attention.