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Designing out violence and aggression
  1. Geoffrey Hughes
  1. Correspondence to Professor Geoffrey Hughes, Department of Emergency, Royal Adelaide Hospital, Adelaide, South Australia, Australia; cchdhb{at}

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It is a sad but regrettable fact that those who work in emergency departments (EDs) have to deal with violent and aggressive behaviour, whatever its aetiology. The UK's National Audit Office reports that such behaviour costs the NHS £69 million a year through staff absenteeism, paying for security, and lost productivity. In England alone, there are 56 000 assaults in NHS hospitals annually. Staff morale, retention and productivity are all affected.1

As a response to this problem, and following an earlier pledge from the Prime Minister to adopt a zero tolerance approach, the Department of Health made an interesting announcement in November last year—it asked the Design Council to help find solutions; the premise is that good and intelligent design has significant potential to make EDs safer. This mirrors well-established design principles that aim to reduce anxiety in other areas of a hospital—not just children's wards—for example, theatres, the ceilings and walls of procedural rooms (including the patient's view from a dental chair), as well as the ceilings and walls of CT/MRI …

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