A narrative review of emergency department design strategies to prevent violence against healthcare personnel: an Indian perspective


Workplace violence in hospitals, specifically in emergency departments (ED), has become a growing concern in recent years. This violence can come from patients, their families, or visitors and can take the form of verbal or physical attacks. Preventing violence in EDs can be achieved through design modifications with minimal personnel and infrastructure requirements. Infrastructure design plays a crucial role in reducing the risk of violence. Private lockers should be available at the ED entrance to limit dangerous objects being brought into the department. Furnishings should be fixed to prevent them from being used as weapons, and evacuation should be facilitated through open rows of seating. Positive distractions, such as gardens or natural areas visible through windows, can reduce stress in patients and lower aggression. Ligature points should be eliminated and tamper-resistant items should be provided to reduce dangers in the built environment. The triage desk should be positioned in a secure area with access control and panic buttons available for staff. Hidden exits should be provided in case of violence and emergency exits should open outward and be lockable only from the outside. It seems that preventing violence in EDs requires a combination of management, technology, planning, and physical design. Proper infrastructure design can play a crucial role in reducing the risk of violence, and healthcare professionals, administrators, and architects should be aware of best practices in ED design.

Ziaei M, Massoudifar A, Rajabpour-Sanati A, Pourbagher-Shahri AM, Abdolrazaghnejad A. Management of violence and aggression in emergency environment: a narrative review of 200 related articles. Adv J Emerg Med. 2018;3(1):e7.

Ghosh K. Violence against doctors: a wake-up call. Indian J Med Res. 2018;148(2):130-3.

Ferns T, Cork A. Managing alcohol related aggression in the emergency department (part I). Int Emerg Nurs. 2008;16(1):43-7.

Davey K, Ravishankar V, Mehta N, Ahluwalia T, Blanchard J, Smith J, et al. A qualitative study of workplace violence among healthcare providers in emergency departments in India. Int J Emerg Med. 2020;13(1):33.

Abdalla S, Apramian SS, Cantley LF, Cullen MR. Occupation and risk for injuries. In: Mock CN, Nugent R, Kobusingye O, Smith KR, editors. Injury prevention and environmental health. 3rd ed. Washington (DC): the international bank for reconstruction and development / the world bank; 2017. chapter 6.

Centers for Disease Control and Prevention. Crime prevention through environmental design (CPTED) school assessment (CSA). Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and Carter & Carter Associates; 2017.

Lenaghan PA, Cirrincione NM, Henrich S. Preventing emergency department violence through design. J Emerg Nurs. 2018;44(1):7-12.

Lo C. The unique challenge of hospital security. Hospital Management. 2010. Available from: https://www.hospitalmanagement.net/features/feature89280/.

Mayo Clinic Safety Screening. Mayo Clinic. Available from: https://www.mayoclinic.org/vid-20536252.

Ulrich RS, Bogren L, Gardiner SK, Lundin S. Psychiatric ward design can reduce aggressive behavior. J Environ Psychol. 2018;57:53-66.

Cox AM. Applying behavioral health design strategies to the ED environment. Health Facilities Management. 2018. Available from: https://www.hfmmagazine.com/articles/3486-behavioral-health-design-strategies.

Huddy J. Design considerations for a safer emergency department. In: Emergency department design: a practical guide to planning for the future. 2nd ed. American College of Emergency Physicians Available from: https://www.acep.org/globalassets/sites/acep/media/safety-in-the-ed/designconsiderationsforsaferemergencydepartment.pdf.

Arostegui JL. Gender and the security sector: towards a more secure future. Connections. 2015;14(3):7-30.

Turgut K, Yavuz E, Yıldız MK, Poyraz MK. Violence toward emergency physicians: a prospective-descriptive study. World J Emerg Med. 2021;12(2):111-6.

National Crime Prevention Council. Crime prevention through environmental design (CPTED) guidebook. 2003. Available from: https://www.ncpc.org.sg.

World Health Organization. Framework guidelines for addressing workplace violence in the health sector. Geneva, Switzerland: International Labour Office. 2002.

Agbola T. The architecture of fear: urban design and construction response to urban violence in Lagos, Nigeria. IFRA-Nigeria; 1997. Available from: http://books.openedition.org/ifra/485>.

Conflict & violence in pubs: design issues. Oxford, UK: MCM Research; 1992. Available from: http://sirc.org/publik/Design2.pdf.

Ramadan M, Fallatah AM, Batwa YF, Saifaddin Z, Mirza MS, Aldabbagh M, et al. Trends in emergency department visits for mental health disorder diagnoses before and during the COVID-19 pandemic: a retrospective cohort study 2018–2021.BMC Psychiatry. 2022;22:378.

Smith TA, Fiel PV, Kosarzycki H, Mac Alister DS, Reginaldi J, Tuohey K, et al. Security design guidelines for healthcare facilities. Glendale Heights, IL: International Association for Healthcare Security and Safety. 2016.

Department of Health & Human Services. Code grey standards. State Government of Victoria, Australia. Available from: https://www.health.vic.gov.au/publications/code-grey-standards.

Smith L. Crime in hospitals: diagnosis and prevention. U.S. department of justice, office of justice programs. 1987. Available from: https://www.ojp.gov/ncjrs/virtual-library/abstracts/crime-hospitals-diagnosis-and-prevention.

Baratloo A, Saberian P, Rezaie M, Kolivand P, Hasani-Sharamin P, Bahreini M. Frequency and types of workplace violence against emergency medical technicians: a cross-sectional study in Tehran, Iran. Front Emerg Med. 2022;6(4):e52

IssueVol 7 No 2 (2023): Spring (April) QRcode
SectionReview article
DOI 10.18502/fem.v7i2.12773
Aggression Architecture Emergency Department Hospital Design and Construction Hospital Planning Workplace Violence

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Musharraf W, Mane S, Musharraf H. A narrative review of emergency department design strategies to prevent violence against healthcare personnel: an Indian perspective. Front Emerg Med. 2023;7(2):e20.


Download data is not yet available.