Improving the management of acute agitation in the emergency department

Abstract

Health services routinely manage acute agitation. Such behaviour is especially prevalent in hospital emergency departments (EDs), and is usually secondary to mental illness and drug or alcohol intoxication. If not managed promptly, acute agitation may progress to aggression and violence, posing a risk to the safety of the individual and healthcare staff or other patients. In the ED, the goal of managing the acutely agitated patient is prevention or safe and rapid control of aggressive or violent behaviour, thereby allowing the underlying cause to be investigated and treated. There is a general consensus that management of the acutely agitated patient should commence with the least aggressive approach. This may involve de-escalation techniques or verbal intervention (talking the patient down), and the granting of requests as required. If these de-escalation techniques are not successful, the use of chemical (drug) sedation and/or physical restraints (manual and/or mechanical) may be required. The research described in this thesis focuses on the management of the acutely agitated patient for whom de-escalation techniques and/or oral drug sedation are not feasible or have been unsuccessful, thus necessitating parenteral drug sedation. Several research methodologies were employed to explore a number of important knowledge gaps in the management of acute agitation in the ED setting. The data generated will contribute towards improving the management of acute agitation through an understanding of current practice, a comparison of sedating drugs and an assessment of resource implications.