Implementation of Safewards into 3 Victorian Emergency Departments: What we adapted and how

Ms Monique Rosenbauer1, Ms  Ashleigh Ryan2, Dr Cathy Daniels3, Prof Marie Gerdtz3, Ms Marisol Corrales4

1Bendigo Health, Bendigo, Australia, 2Peninsula Health , Frankston, Australia, 3University of Melbourne, Carlton, Australia, 4Department of Health and Human Services, Melbourne, Australia

Safewards is an internationally acclaimed model aimed at reducing harm (conflict) and reducing the restrictive response to events that can lead to harm (containment),  while promoting safety. The Safewards model originated in the UK, and following a successful trial was rolled out to all mental health services in Victoria, Australia. Staff and patients reported increased engagement, safety and confidence in preventing conflict, or reducing its impact. The results also demonstrated a reduction in the use restrictive interventions, which are known to cause harm to patients and staff.  The need for a similar change in Emergency Departments (ED) was highlighted, and in July 2018, the Safewards in the ED trial commenced.

The Safewards ED pilot focuses on improving outcomes and experiences for patients presenting to ED and staff.  The model also aims to address increasing rates of occupational violence in an environment where patients are often acutely unwell on arrival, length of stay is short, turnover is rapid, and time to build rapport is limited.  The ten ED Safewards interventions have been adapted to reflect this unique environment.  Each intervention is designed to reduce ‘flashpoints’, or situations that may lead to conflict.  Using an exploratory model, staff and patients in the ED have been challenged to look for ways of improving their interactions and enhancing their environment, using creative and simple measures.

This paper will outline how an evidence based and adaptable model is being implemented to a new environment, with a new patient population.   The model’s potential impact on staff culture, de-escalation skills, collaboration, and language will also be explored.  The 10 interventions and exploring the impact of Safewards in ED has not been previously reported. This paper will describe the 10 skill based interventions, challenges, opportunities and the innovative nature of this intervention in the ED setting.


Monique Rosenbauer and Ashleigh Ryan are project leads for the two sites undertaking the Safewards in Emergency Department (ED) pilot project. Monique is a Mental Health Nurse and Social Worker in the Bendigo Health ED and Ashleigh a Clinical Nurse Specialist in the Frankston ED at Peninsula Health. Together they have many years of working with and supporting patients and their families who have complex health and/or safety needs, high risk concerns and vulnerability. They are currently working together to creatively adapt the success of Safewards in mental health inpatient units to the ED environment.