Episode 13 - Workplace Violence: Part 3
Play • 1 hr 2 min

Theme: Workplace Violence. 


Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. 

Davids J, Murphy M, Moore N, Wand T, Brown M. Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. Int Emerg Nurs. 2021 Jul;57:101017. doi: 10.1016/j.ienj.2021.101017. Epub 2021 Jun 24. PMID: 34174545. 


Amanda De Silva (emergency medicine trainee at Westmead Hospital). 


  • It is widely recognized that emergency departments (EDs) are a high-risk environment when it comes to violence towards healthcare workers. 
  • A big contributor to this is the environment in the ED – it is chaotic, messy, busy, and sees a large turnover of patients. Compounded by access block and understaffing, this often exacerbates tense and potentially volatile situations. 
  • The Australian College of Emergency Medicine has created a policy regarding violence in emergency departments to provide a guideline by which departments can maintain a safe working environment. 
  • They examine the Code Black response and identify important elements of ED design to encourage a positive patient journey through the ED. 
  • This observational study was conducted in the Western Sydney Local Health district across four hospitals, one of which is Westmead Hospital. 
  • It involved interviewing 20 staff members from across the four sites to gauge their personal experience with violence in the emergency department. The data was analyzed and codes were created to capture concepts in the data. 
  • The study identified several points of interest when it comes to Code Blacks. 
  • Perpetrators of these events tended to be patients who had presented with drug or alcohol-related illness, as well as mental illness. 
  • There are several common triggers of violence, including extensive wait times, frustration/fear/anxiety, and being involuntarily detained for psychiatric care. 
  • Staff members feel undertrained when it comes to responding to violence in the ED – 6/20 staff reported not being given formal training when starting their job in ED, while many others reported learning through on-the-job training and observation. 
  • Good communication was identified as crucial to managing an escalating situation. 
  • Staff members were unsure when to activate a Code Black, and also reported feeling reluctant to call one for fear of interrupting other busy colleagues. 
  • There is no culture of formal debriefing after a Code Black, and staff members are often left to manage their own stress. 


Take-Home Points 

  • Communication and de-escalation skills are vital to the Code Black response and in preventing violence in the ED. 
  • Early escalation of concerns about agitated patients is important, to allow for these communication skills to be utilized and to diffuse escalating situations before they reach a point of physical violence. 
  • More education is required around the Code Black response, with particular attention paid to the specific roles of each member of the response team and how they can assist in managing violent situations. 

This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. 

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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.


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