Remarkable changes: QEII emergency department enhances safety measures

The QEII Health Sciences Centre’s emergency department (ED) is now safer and more supportive for all. 

Peter Hico, a paramedic with over a decade of experience in the ED, witnessed the positive impact of the new safety measures for staff and patients, including an increased presence of security personnel strategically placed around the department.  The changes took place in February. 

“We now have capable people with a physical presence placed around all exits,” Peter said. “They circulate a lot and make conversation with staff and patients. They are very approachable and friendly. 

Security’s proactive approach contributed to a safer and more efficient emergency department. "I have seen officers helping patients to wheelchairs or helping patients back to their rooms. They know how to interact and are respectful with violent and abusive patients. They follow the lead of clinical staff and work together in a unified way," he said.  

Peter says that as a result, staff can focus more on their clinical duties and less on security concerns. 

"The ED is a very volatile environment. I have been physically and verbally assaulted numerous times, largely because I was called on due to my larger physical presence. I am grateful that security can now do that job and I can relax my mind and focus on clinical care.” 

The ED incident management team played a crucial role in putting in place several key security steps, such as installing a metal detector, which has been effective in locating weapons or weapon-like items. The team also introduced a visitor pass system to enhance security and is exploring the use of artificial intelligence for weapon detection. Additionally, the team worked on policies for managing potential violence and aggression, ensuring that staff are well-prepared to handle such situations. 

Long-time emergency department physician, Dr. Amy Nason, noted leadership support resulted in rapid and meaningful change. 

“Although the department experienced a significant security incident which catalyzed these changes, it was part of a broader context of unaddressed situations,” Amy said. "This incident led to a profound culture shift within the ED, prioritizing safety and demonstrating remarkable flexibility and adaptability." 

The ED transformed into a space where safety is paramount. "This transformation should serve as reassurance to those considering joining the team. We are now a dynamic and responsive department dedicated to the well-being of its staff and patients,” Amy added. 

Since 2001, Haley Avery, a clinical nurse educator, worked in various capacities within the ED and experienced the evolution of safety measures and their profound effects.  

"The metal detectors have been a huge improvement,” Haley said. “The triage RNs and waiting room care providers were previously very vulnerable to anyone who walked through the door with a possible weapon. Having a very thorough checkpoint with a metal detector before being able to enter has made a big impact." 

Haley appreciated the introduction of visitor passes, ensuring that everyone within the ED is identifiable. Security officers are diligent about making sure visitors and staff members display their ID visibly. 

Like Peter, Haley is reassured by the presence of new security personnel who are trained in physical intervention and de-escalation techniques.  "This skill set is so important in a busy ED where people are often in crisis and experiencing possibly the worst day of their life,” adds Haley. 

Another recent improvement is the introduction of a staff alert communication system, called Vocera, which allows for a rapid response to any threats or violence. Now, each team member carries a personal communication device. “It is a comfort knowing that help is available with just a push of a button," Haley said. 

Haley offers a message of encouragement to future potential team members: “I can confidently say that the Halifax Infirmary ED has made safety improvements that have exceeded everyone’s expectations. We are now getting phone calls from EDs from across the country to inquire about what we have done." 

With strict access control, personal communication devices, appropriately trained security personnel and metal detectors, Haley feels it has become one of the safest EDs in Canada. Now, ED staff and physicians can focus on providing excellent care to their patients without the heightened fear of violence.  

Photo: Peter Hico, Dr. Amy Nason (top) and Haley Avery.