Mental Health Units, Emergency Departments and other hospital and care environments are places where higher levels of aggression and frustration can occur. Within these environments there can be specific locations/areas which have an even greater concentration of aggression and frustration. These locations can be described as Hot Spots. (Gillespie et al 2018).   In the safe wards literature, the physical environment is one of six domains or categories of factors that can give rise to flashpoints, which have the capacity to trigger conflict and/or containment.  (Bowers, 2014).

This article will explore how to identify Hot Spots (and Hot What’s) and some solutions to address them.

To assist with identifying Hot Spots:

1.       Listen to lived experience reports and complaints of locations/areas on the units that have negative sensory or other aspects. Eg noisy scraping of chairs in kitchen,  loud alarm near nursing station.

2.       Use a map of the unit and mark any incidents on the map. Any area that contains a greater frequency of incidents is considered a Hot Spot (Cygnet 2024).

Once the Hot Spots are identified, the next step is to identify the Hot What’s – meaning what sensory or other input is problematic and resulting in the area becoming a Hot Spot.

Hot What’s can be identified by:

1.       Listening to lived experience reports and complaints of problematic sensations

2.       Completing a sensory audit of the Hot Spot/s, for example identify the sensory input of that place. Using the sensory audit ‘sensory input in mental health units’ might be a good starting point.

3.       Completing a sensory audit at the time or not long after the incident. Using the sensory audit tool ‘Sensory Factors in the home environment’ might be helpful.

Solving Hot Spots and Hot What’s:

After identifying the location of the Hot Spots and the Hot What input, it is important to then identify locally achievable solutions. Options to consider include -

1.       Change the sensory input (eg replace loud alarms with vibration alarms)

2.       Reduce the sensory input for the individual (eg supply sensory modulation items to reduce sensory input such as earplugs, personal scents* to mask other scents. ). Scent needs to be personalised and self applied/not diffused through public spaces. Refer to blog for more information:

3.       Support the individual to move away from the input (eg to go outside for a break, offer a different room or a different ward that does not contain the problematic input).

A similar process could be used in a range of different environments including schools, support facilities and housing/accommodation options.

Case Study

An outcome of training conducted by Sensory Modulation Brisbane for Cygnet Health Care in the UK  has been greater identification of Hot Spots. The Cygnet OTs were able to identify Hot Spots and then develop sensory modulation plans to change the sensory input or make other changes (eg move the person to another room or space). This process resulted in a significant decrease in  seclusion and restraint incidents.

 Definition

Hot What’s = Sensory Modulation Brisbane term to describe the sensory input that is present at hot spots.

 References

Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014 Aug;21(6):499-508. doi: 10.1111/jpm.12129. Epub 2014 Feb 19. PMID: 24548312; PMCID: PMC4237187.

Cygnet 2024. Sensory Modulation Brisbane completed training at Cygnet and an outcome of this training was greater identification of hot spots. The Cygnet OTs identified hot spots and developed sensory modulation plans to change the sensory input or make other changes.

Gillespie A, Reader TW. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety. Milbank Q. 2018 Sep;96(3):530-567. doi: 10.1111/1468-0009.12338. PMID: 30203606; PMCID: PMC6131356.

Safe Wards: https://www.safewards.net/model/technical