Beyond Restraint: A Systematic Review of Interprofessional Hospital Emergency Responses to Violence Integrating Security, Clinical, and Sociological Frameworks
Abstract
Background: Hospital violence, stemming from patients, visitors, or societal conflict spillover, constitutes a critical threat to staff safety, patient care, and institutional integrity. Traditional "Code-Silver" responses often default to security-led containment, potentially escalating situations and neglecting underlying causes. An integrated interprofessional approach is required to address the clinical, psychological, and sociological complexity of in-hospital aggression. Aim: This narrative systematic review synthesizes evidence on interprofessional emergency responses to hospital violence, mapping the roles of health security, emergency medicine, nursing, clinical pharmacy, and sociological frameworks in de-escalation, clinical management, and post-event resilience. Methods: A systematic search of PubMed, CINAHL, PsycINFO, and Scopus (2010-2024) was conducted. Data were analyzed thematically to evaluate models of team integration, intervention efficacy, and systemic learning. Results: Effective responses are characterized by pre-emptive, integrated protocols. Health security personnel trained in trauma-informed de-escalation, supported by nursing-led verbal engagement and rapid clinical assessment, reduce physical restraint use. Clinical pharmacists improve the safety and efficacy of pharmacologic sedation. Incorporating sociological analysis into post-incident reviews uncovers root causes (e.g., systemic inequity, care delays) and informs restorative practices, reducing recurrence. Interdisciplinary simulation training emerged as a key facilitator of team efficacy. Conclusion: Moving from a security-centric "Code-Silver" to a holistic "Code-Social" model necessitates systematic integration of clinical and sociological expertise with security operations. This paradigm shift, supported by joint training and shared mental models, enhances safety, improves patient care, and fosters a resilient institutional culture.
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Authors
Copyright (c) 2024 Nasser Ibrahem Nasser Almohaizef, Fatimah Mohammed Ali Hakami, Abdulmajeed Abdulrahman Alanazi, Salha Saeed Alahmari, Arif Mohammed Almotari, Waleed Eid Almutairi, Adel Eid Almutairi, Jawaher Tami H Alkahtani, Khalid Ali Sahhari, Jalilah Adnan Alsaigh, Samar Adnan Alsadah, Layla Jaffar Alkhudear, Norah Shafi Dawi Alghamdi, Saif Allah Atiah Bakri
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