The Patient Care Paradox

An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department

Ambrose Hon Wai Wong, Joan Combellick, Beth Ann Wispelwey, Allison Squires, Maureen Gang

Research output: Contribution to journalArticle

Abstract

Objectives: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions. Methods: We conducted uniprofessional focus groups and individual interviews using a phenomenologic approach with emergency medicine resident physicians, ED staff nurses, patient care technicians, and hospital police officers at an urban hospital in New York City. Audio recordings were transcribed and coded for thematic analysis using the constant comparison method. Results: We reached theoretical saturation with 31 interprofessional participants. Three broad themes emerged from our analysis: 1) ED healthcare workers provide high-quality care to a marginalized patient population that concurrently poses safety threats, creating a patient care paradox; 2) teamwork is critical to safely managing this population, but hierarchy and professional silos hinder coordinated care between healthcare professionals; and 3) environmental challenges and systems issues both in and outside the ED exacerbate threats to safety. Conclusion: The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.

Original languageEnglish (US)
Pages (from-to)226-235
Number of pages10
JournalAcademic Emergency Medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Hospital Emergency Service
Patient Care
Delivery of Health Care
Safety
Violence
Workplace Violence
Population
Emergency Medicine
Quality of Health Care
Urban Hospitals
Expert Testimony
Police
Focus Groups
Nurses
Interviews
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The Patient Care Paradox : An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department. / Wong, Ambrose Hon Wai; Combellick, Joan; Wispelwey, Beth Ann; Squires, Allison; Gang, Maureen.

In: Academic Emergency Medicine, Vol. 24, No. 2, 01.02.2017, p. 226-235.

Research output: Contribution to journalArticle

Wong, Ambrose Hon Wai ; Combellick, Joan ; Wispelwey, Beth Ann ; Squires, Allison ; Gang, Maureen. / The Patient Care Paradox : An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department. In: Academic Emergency Medicine. 2017 ; Vol. 24, No. 2. pp. 226-235.
@article{73b09cca40b94cd6a9e81263f40551ac,
title = "The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department",
abstract = "Objectives: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions. Methods: We conducted uniprofessional focus groups and individual interviews using a phenomenologic approach with emergency medicine resident physicians, ED staff nurses, patient care technicians, and hospital police officers at an urban hospital in New York City. Audio recordings were transcribed and coded for thematic analysis using the constant comparison method. Results: We reached theoretical saturation with 31 interprofessional participants. Three broad themes emerged from our analysis: 1) ED healthcare workers provide high-quality care to a marginalized patient population that concurrently poses safety threats, creating a patient care paradox; 2) teamwork is critical to safely managing this population, but hierarchy and professional silos hinder coordinated care between healthcare professionals; and 3) environmental challenges and systems issues both in and outside the ED exacerbate threats to safety. Conclusion: The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.",
author = "Wong, {Ambrose Hon Wai} and Joan Combellick and Wispelwey, {Beth Ann} and Allison Squires and Maureen Gang",
year = "2017",
month = "2",
day = "1",
doi = "10.1111/acem.13117",
language = "English (US)",
volume = "24",
pages = "226--235",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - The Patient Care Paradox

T2 - An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department

AU - Wong, Ambrose Hon Wai

AU - Combellick, Joan

AU - Wispelwey, Beth Ann

AU - Squires, Allison

AU - Gang, Maureen

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objectives: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions. Methods: We conducted uniprofessional focus groups and individual interviews using a phenomenologic approach with emergency medicine resident physicians, ED staff nurses, patient care technicians, and hospital police officers at an urban hospital in New York City. Audio recordings were transcribed and coded for thematic analysis using the constant comparison method. Results: We reached theoretical saturation with 31 interprofessional participants. Three broad themes emerged from our analysis: 1) ED healthcare workers provide high-quality care to a marginalized patient population that concurrently poses safety threats, creating a patient care paradox; 2) teamwork is critical to safely managing this population, but hierarchy and professional silos hinder coordinated care between healthcare professionals; and 3) environmental challenges and systems issues both in and outside the ED exacerbate threats to safety. Conclusion: The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.

AB - Objectives: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions. Methods: We conducted uniprofessional focus groups and individual interviews using a phenomenologic approach with emergency medicine resident physicians, ED staff nurses, patient care technicians, and hospital police officers at an urban hospital in New York City. Audio recordings were transcribed and coded for thematic analysis using the constant comparison method. Results: We reached theoretical saturation with 31 interprofessional participants. Three broad themes emerged from our analysis: 1) ED healthcare workers provide high-quality care to a marginalized patient population that concurrently poses safety threats, creating a patient care paradox; 2) teamwork is critical to safely managing this population, but hierarchy and professional silos hinder coordinated care between healthcare professionals; and 3) environmental challenges and systems issues both in and outside the ED exacerbate threats to safety. Conclusion: The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.

UR - http://www.scopus.com/inward/record.url?scp=85011556967&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011556967&partnerID=8YFLogxK

U2 - 10.1111/acem.13117

DO - 10.1111/acem.13117

M3 - Article

VL - 24

SP - 226

EP - 235

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 2

ER -