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How ‘progression’ could reduce aggression in A&E departments

Posted on Fri 28th Jun, 2019 in: Healthcare ProjectsHospital Design

A&E waiting room with wall murals

Designing around the concept of flow to reduce frustration


Aggression and abuse is a growing problem in healthcare and a serious issue for those working in the sector with around 15% of NHS staff experiencing physical violence from patients, relatives or members of the public according to the latest NHS Staff Survey. Nowhere is this more prevalent than in A&E departments where the frustrations of waiting for long periods, with the added factors of alcohol, drugs, pain, mental ill-health and even fear that have led many to find themselves there, mean that front line staff here often face abuse during the course of their work.


Bristol architect practice, BDP has recently delivered an extensive renovation of the A&E department at Wrexham Park Hospital in Berkshire (see here for details) which offers a very different approach to emergency assessment design. Nick Fairham, architect director at BDP spoke of their approach:


“We looked at a lot of available research, including issues around designing A&E departments to reduce incidents of violence and aggression and, in understanding patient flow; it became apparent that, from arrival at the department, patients needed to feel as if they were progressing.”


Many A&E departments have a single waiting area so a patient comes into the department and is directed to this waiting area, is called into triage and then returns to the same waiting area. They may have further tests such as X rays or blood tests but they often still return back to the same area. This can make them feel that they are not progressing and that’s when frustrations can develop. Seeing people who were there before you returning back into the space can also add to the sense of it taking a long time.


The approach that this project has taken is to create several assessment areas within the department that allow patients to move through each stage of their assessment and treatment. It means that once you have left one space, you don’t return to it, which reinforces the perception that you are making progress. A different environment can also help to reduce boredom.


We think this is a really interesting idea and while not every hospital has a £49 million budget to revamp their buildings, there are ways that this idea of progression and flow could be incorporated into many existing departments.


We would recommend that each different space has a different feel to it as moving a person from one room to a near identical one may not achieve the same results as transferring to one that is not only a different location but looks very different as well. Changing the environment in a visual sense will not only create a perception of progression but help to relieve some of the boredom, especially if each space is visually stimulating and does not feel too ‘institutional’ as many hospital spaces do. A really useful way to achieve this is through large scale wall murals. These will add colour and can be used to bring the outdoors in. These could be vibrant, stimulating images or calm, relaxing vistas, as appropriate.


Of course, this may not be possible in many hospitals due to lack of facilities but that doesn’t mean the idea should be simply dismissed. By ‘zoning’ waiting areas, clearly marking them out through colour, wall coverings and signage, people can be directed to move through different parts as they progress still creating a sense of flow.


You can see how adding interest to an A&E department through colour and images worked at this project completed at Bradford Royal Infirmary. If you would like more information about how wall murals or signage can be used to help A&E departments feel less institutional and achieve ideas like those described here, please call us on 01274 728831 or send us a message.


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