How virtual reality is helping hospitals deal with soaring rates of violence

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Key points

  • WorkSafe Victoria estimates 95 per cent of healthcare workers have been verbally or physically assaulted at work.
  • In 2014, a brain surgeon was left fighting for his life after being stabbed in the foyer at a hospital in Footscray.
  • A world-first training program at Western Health has seen reductions in staff injuries and time off due to violence.

Doctor Andy Tagg says being an emergency physician can sometimes feel a bit like being a nightclub bouncer.

You learn to read the crowd and remain alert for signs of looming danger.

Western Health, where Andy Tagg works, has reported a 59 per cent drop in workplace injuries and leave due to instances of violence.Credit: Jason South

In the past 25 years, Tagg has been spat at and sworn at. Cups of coffee, chairs, trays of food and fire extinguishers have been hurled at him and his colleagues. But most vivid in his mind are patients who have wielded intravenous drips or scalpels as weapons.

“I remember one patient who was really distressed partly because of medical reasons, and also being under the influence of drugs and or alcohol, and they were standing in a cubicle … waving a scalpel around the place,” Tagg said.

“If you’re on the street, you can run away, but inside a hospital, this person has been brought in because they need our help. We have a duty of care to them.”

Across Australia and the world, there has been an explosion of violence reported against healthcare workers during the pandemic fuelled by elevated drug and alcohol use and an escalating number of patients and their carers, frustrated by record-long waiting times in hospital emergency departments, who are lashing out.

But Western Health, where Tagg works, is bucking this global trend. The health service, which runs Sunshine and Footscray hospitals in Melbourne’s western suburbs, has reported a 59 per cent drop in workplace injuries and staff time off due to instances of violence.

It is something the health service attributes to a world-first training program aimed at teaching staff how to detect and de-escalate potentially dangerous situations.

The program, ‘Predict, Prevent, Priority: Safety’ was first introduced to emergency departments in 2019, sparking a notable drop in code grey alerts – a hospital response to violent, aggressive, abusive or threatening behaviour from patients or visitors.

The program was later rolled out across the entire health service. It now includes virtual reality interventions, which transport staff into immersive and stressful situations where a patient or their family might become violent or aggressive, giving them experience on how to respond.

Nurses respond to an aggressive patient in a virtual reality training program at Western Health.Credit: Western Health

In one scenario, an intoxicated man presents to the ED after being injured in a brawl and aggressively threatens staff, demanding to be seen immediately. In another case, a confused and disorientated patient in a hospital bed begins throwing things at a nurse.

Tagg said the program teaches staff the early signs to look out for, such as a patient muttering to themselves, becoming irritable, or snapping at staff, and the skills to intervene to de-escalate dangerous situations.

The senior doctor said the program was especially beneficial for early career staff because it exposed them to complex scenarios they had not yet encountered, and he hoped it would lessen the moral injury of traumatic workplace incidents when they occurred. WorkSafe Victoria estimates 95 per cent of healthcare workers have experienced verbal or physical assault at work.

“It empowers them to be able to say ‘hey, something’s not going right here’ and build up trusting their gut feeling early in their careers,” Tagg said.

Tagg said diffusing a situation could involve providing medication to somebody withdrawing from drugs or alcohol waiting in the emergency department, or ensuring an agitated patient was given enough pain medication to keep them comfortable. Tagg sometimes said it was as simple as empathising with a person so they feel heard, or getting assistance from a senior staff member.

“In a worst case scenario when someone is very psychologically distressed and fearful for what’s going on, we want to provide the best sort of trauma-informed care we can to that person,” said Tagg, who wants the program rolled out at every hospital nationally.

“Our daily business is to look for vital signs, we check someone’s pulse, their blood pressure, their oxygen levels, but as part of that we need to also check for signs of agitation.”

Tagg said while the overwhelming majority of patients were grateful for the care they received, people often arrived in the emergency department on the worst day of their life.

An image of a nurse from a virtual reality training program at Western Health.Credit: Western Health

“Sometimes it’s because the system has brought them down,” Tagg said. “They’re homeless, unemployed, they’re addicted to medication and it can feel very confronting for them … they will lash out.”

Incidents of violence against healthcare workers have had tragic outcomes over the years. In 2014, brain surgeon Dr Michael Wong was left fighting for his life after being stabbed in the foyer at a Western Health hospital in Footscray as he arrived for work.

The same year, Melbourne heart surgeon Patrick Pritzwald-Stegmann was killed in a one-punch attack outside the Box Hill Hospital. In 2019, a junior doctor was also brutally assaulted by four men while leaving work at Sunshine Hospital.

Tagg recalled working in a major Melbourne hospital more than a decade ago where it was common practice to put patients, who might be in the grips of drugs or alcohol-fuelled crisis, into isolation rooms he described as “almost like a holding cell”.

“Sometimes they would be picking up chairs and be using those as potential weapons against nursing and medical staff and we would have to call in the CIRT (critical incident response team) so police could open the door for us,” Tagg said.

“So much has been learnt since then and there has been a real recognition that type of response does nobody any favours, and it just compounds any potential traumas going on.”

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