Table 3 Violence prevention measures addressed by participants

Alarm systems

- Permanently installed or carried devices

- Loud or silent alarm

General structure of the ED

- Patient flow

- Open and calming atmosphere

- Secured equipment

- Means of escape

Staff organisation

- Exchanging the responsible colleague

- Supporting colleagues during violent incidents

- Attending potentially aggressive patients

Training regarding violence prevention

- Education on causes of violence, early warning signs, verbal de-escalation, or self-defence

Communication

- Patient information (e.g., explaining waiting periods)

- Means of information and entertainment (e.g., video screens, posters, or patient information systems)

Locking systems

- Restricted access to (the core area of) EDs

Registration and waiting areas

- Registration area: welcoming design while considering staff safety

- Waiting area: either outside of the ED or inside to make the workload visible; providing water and snacks

Security service

- Intervening verbally and physically

- Quick availability

Staff care

- Support from supervisors

- Promoting stress resistance

Access restrictions

- Expelling aggressive patients and attendants from the ED

- Restricting access for attendants

Records of violent incidents

- Free-text entries, protocols, or attributes assigned in patient files

Police

- Last resort, mostly called in cases of physical violence

Camera surveillance

- For crucial areas inside and outside of the ED

Treatment rooms

- Single rooms, especially for individuals with substance misuse or psychiatric patients

Guidelines and standard operating procedures (SOPs)

- Written instructions regarding violence prevention

Physical restraint

- As a last resort to prevent aggressive patients from hurting themselves or others

Screening tools

- Assigning higher urgency to anxious or aggressive patients

Structural conditions

- Specialised treatment centres for individuals with substance misuse

- Outpatient clinics