Hospital takes new tack to cope with aggression

The Royal Children’s Hospital in Melbourne, created a team – dubbed “code grey” –  to respond to incidents and “improve clinical risk, staff safety and patient care”, according to the research by Dr Sandy Hopper, an emergency physician at the hospital, and coauthors.

Over 14 months, the team was activated 104 times. These incidents involved patients in 75 cases and visitors in 29 cases – and occurred at equal frequency on wards and in the emergency department. Females were more likely to be aggressors than males.

Forceful measures such as physical restraint were used in 34 out of 75 cases, sedation in 23 out of 75 cases and mechanical restraint (involving padded straps) in 15 out of 75 cases. Confinement in an emergency department “safe room” was used 11 times.

“Even when stipulated as a last resort, restraint is used in over half of cases involving patients, and a substantial proportion of visitors (over one-third) were either escorted from the hospital or left voluntarily”, wrote the authors.

Even so, during the study, no serious injuries to staff occurred, though two patients sustained self-inflicted minor injuries, and one visitor inflicted facial fractures on another visitor before the team had arrived. No patients were injured during physical or chemical restraint, according to the authors.

In an accompanying editorial, Brett McDermott from the Child and Youth Mental Health Service at Mater Health Services in Brisbane wrote that in many hospitals, reliable data on verbal abuse and physical assaults are scarce, the management response is ad hoc and staff are given no training to manage aggression.

“It is reasonable to suggest that investment in aggression management strategies would be cost-effective if it leads to less violence in the workplace, less time off work and higher rates of staff retention”, he wrote.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA or the MJA unless that is so stated.

CONTACTS:             Dr Sandy Hopper                                   0417 177 767

                             Prof Brett McDermott                              0404 821 818