Objectives: To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations.
Design, setting and participants: A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014.
Main outcome measures: The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff; the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff.
Results: In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%).
Conclusions: Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.
- 1. Egerton-Warburton D, Gosbell A, Wadsworth A, et al. Survey of alcohol-related presentations to Australasian emergency departments. Med J Aust 2014; 201: 584-587. <MJA full text>
- 2. Egerton-Warburton D, Gosbell A, Wadsworth A, et al. Survey confirms alcohol-related presentations to Australasian emergency departments are under-reported [abstract]. 31st Annual Scientific Meeting of the Australasian College for Emergency Medicine, Melbourne, Australia, 7–11 December 2014. Emerg Med Australas 2015; 27 (Suppl 1): 6.
- 3. Kowalenko T, Walters BL, Khare RK, et al; Michigan College of Emergency Physicians Workplace Violence Task Force. Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med 2005; 46: 142-147.
- 4. Hills DJ, Joyce CM, Humphreys JS. A national study of workplace aggression in Australian clinical medical practice. Med J Aust 2012; 197: 336-340. <MJA full text>
- 5. Downes MA, Healy P, Page CB, et al. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas 2009; 21: 196-202.
- 6. Gillespie GL, Gates D, Berry P. Stressful incidents of physical violence against emergency nurses. Online J Issues Nurs 2013; 18: 2.
- 7. Nachreiner NM, Gerberich SG, Ryan AD, et al. Minnesota Nurses’ Study: perceptions of violence and the work environment. Ind Health 2007; 45: 672-678.
- 8. Hills DJ, Joyce CM, Humphreys JS. Workplace aggression in clinical medical practice: associations with job satisfaction, life satisfaction and self-rated health. Med J Aust 2014; 201: 535-540. <MJA full text>
- 9. Hegney D, Eley R, Plank A, et al. Workplace violence in Queensland, Australia: the results of a comparative study. Int J Nurs Pract 2006; 12: 220-231.
- 10. Spencer S, Stone T, McMillan M. Violence and aggression in mental health inpatient units: an evaluation of aggression minimisation programs. HNE Handover for Nurses and Midwives 2013; 3: 42-48. http://journals.sfu.ca/hneh/index.php/hneh/article/view/70 (accessed July 2015).
- 11. Hills DJ, Joyce CM. Personal, professional, and work factors associated with Australian clinical medical practitioners’ experiences of workplace aggression. Ann Occup Hyg 2013; 57: 898-912.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.