Deriving a framework for a systems approach to agitated patient care in the emergency department.

The Joint Commission issued a sentinel event alert highlighting workplace violence as a major safety problem. Certain clinical areas such as inpatient psychiatric units and emergency departments (ED) are particularly vulnerable, in part due to the presence of higher numbers of patients whose behavior may be unpredictable. In this mixed-methods study, researchers describe the development of a safety framework to improve care for agitated patients in the ED. Attending physicians, residents, physician assistants, nurses, technicians, and security officers participated in a simulated encounter with an agitated patient and in focus groups following the scenario. They also completed surveys prior to the simulation and focus groups, which researchers analyzed to form their framework. The authors suggest that their theoretical framework can help guide research, practice, and policy related to health care improvement. A recent WebM&M commentary discusses a case involving a patient who presented to the ED after a suicide attempt.