An integrative review of waiting time, queuing, and design as contributory factors to emergency department violence.

Abstract

Reports of violence in health care are continuously increasing. Globally there are attempts to manage this phenomenon. However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. Alcohol and drug misuse, for example, are frequently reported, with limited consideration of the ED environment. By far the biggest cause of violence appears to be the presentation of conditions related to or accompanied by mental illness and the impact of queuing and crowded departments on patients and their families. This study aims to examine the extent to which ED waiting times, design and queuing are linked to ED violence. An integrative literature review was performed using CINAHL Complete and MEDLINE databases. 110 papers were initially selected, and the final analysis included 25 papers. The literature revealed three emerging themes: the nature of emergency department violence, environmental contributory factors and its management and control. The findings of this review reveal several causes of violence. Surprisingly most approaches take a victim blaming approach aimed at identifying potential perpetrators rather than taking a holistic approach to prevention that would also address environmental and societal issues. More is needed in terms of implementation of more far-reaching, practical, and effective management solutions to promote health care workers' safety and adequately support vulnerable patients.