Emergency Medicine Residency Program Director University of Toledo College of Medicine and Life Sciences Toledo, Ohio, United States
Objectives: We hypothesized that some techniques utilized by ED staff would be less effective than other techniques at reducing tension.
Background: Due to the unique nature of the work environment in the emergency department, healthcare providers and staff in the ED often adapt unique strategies to respond to periods of increased tension that can regularly occur at work. This study aimed to identify the most effective techniques used by ED staff to rapidly de-escalate tension. Tension among staff may impair performance and team cohesion, therefore it is important to understand which techniques will effectively decrease this tension and which will not.
Methods: An online survey was administered to staff from seven separate emergency departments. Of 634 potential participants, 163 responses were received, representing physicians, nurses, PAs, NPs, and clinical support staff. Participants indicated if they had experienced a period of increased tension in the emergency department, and chose which techniques they used to de-escalate this tension. For each technique selected, participants rated perceived effectiveness at de-escalating tension on a personal level and among their healthcare team, ranging from completely effective (5) to not at all effective (1). ANOVA was used to analyze for significant differences between technique effectiveness.
Results: Of 163 participants, 152 participants (93.3%) reported experiencing a period of increased tension while working in the ED and these responses were further analyzed for techniques used in response to tension. “Withdrawing or becoming silent” in response to tension was shown to be significantly less effective than the other techniques at reducing tension on both a personal and team level (p < 0.001). There were no significant differences in the perceived effectiveness of other techniques used. Humor was the most commonly reported technique (84.2% reported) while motivational speech was the least commonly reported (13.82%).
Conclusions: Withdrawing oneself from the situation was shown to be least effective at de-escalating tension. Therefore, a proactive approach to resolving tension in the ED was shown to be more efficacious, regardless of which proactive technique was used. This data, along with the relative levels of technique effectiveness, can inform an approach to resolving tension that can be utilized by medical staff in emergency departments across the country.
