@article{ref1,
title="Deriving a framework for a systems approach to agitated patient care in the emergency department",
journal="Joint Commission journal on quality and patient safety",
year="2018",
author="Wong, Ambrose H. and Ruppel, Halley and Crispino, Lauren J. and Rosenberg, Alana and Iennaco, Joanne D. and Vaca, Federico E.",
volume="44",
number="5",
pages="279-292",
abstract="BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. <br><br>METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network. Participants consisted of resident and attending physicians, physician assistants/nurse practitioners, nurses, technicians, and security officers. After a simulated agitated patient encounter to prime participants, uniprofessional and interprofessional focus groups were conducted, followed by a structured thematic analysis using a grounded theory approach. Quantitative data consisted of surveys of violence exposure and attitudes toward patient aggression and management. <br><br>RESULTS: Data saturation was reached with 57 participants. Violence exposure was higher for technicians, nurses, and officers. Conflicting priorities and management challenges occurred due to four main interconnected elements: perceived complex patient motivations; a patient care paradox between professional duty and personal safety; discordant interprofessional dynamics mitigated by respect and trust; and logistical challenges impeding care delivery and long-term outcomes. <br><br>CONCLUSION: Using a systems approach, five interconnected levels of ED agitated patient care delivery were identified: patient, staff, team, ED microsystem, and health care macrosystem. These care dimensions were synthesized to form a novel patient safety-based framework that can help guide future research, practice, and policy.<br><br>Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1553-7250",
doi="10.1016/j.jcjq.2017.11.011",
url="http://dx.doi.org/10.1016/j.jcjq.2017.11.011"
}