Thematic analysis of interviews’ preintervention
| Themes | Quotes | Comment | |
| 1. Unfamiliarity of C-ART terminology | Doctor | My junior medical officer said there is a C-ART being called and I said what on earth is that? | Doctors were less familiar with the term C-ART, compared with other staff. Orientation to C-ART was not provided to doctors starting a new term within the hospital. |
| 2. Effective pharmacological sedation of patients in a timely manner | Doctor | I found that by the time I am called, everyone else is slightly at breaking point and the pressure is on you when walking in the door is to prescribe a drug… and often I felt that you were slightly pressured into using medication before exploring other options. | Doctors felt pressured to prescribe benzodiazepines and antipsychotics. They were unaware of the Adult Sedation Guideline and hence felt unsure at times which medication to use or at what dose. |
| 3. Lack of clear understanding of the role and responsibilities of team member | Doctor | Basically, I didn’t know exactly what my role was. I didn’t know if I was supposed to be there or not. | The role of the doctor during C-ART calls was not clear. |
| 4. Significant time constraints placed on team members, many with competing priorities, leading to less time to address the primary cause of the behavioural disturbance | Doctor | Usually, we need to give medication and go and run because I have something else on. I don’t have time to see the patient. | |
| 5. Communication | |||
| a. Poor handover at the commencement of a C-ART call | Doctor | Sometimes you don’t get that information and then it is hard to piece it all together yourself. You can’t really spend too much time trawling through the notes. | Doctors spend a significant amount of time gathering information about the patient due to the lack of a comprehensive handover to the C-ART team. |
| b. Difficulty and inexperience de-escalating aggressive patients | Doctor | It can be intimidating, especially when patients are very abusive. | Approaching and managing aggressive patients can be troubling for many staff members. Sometimes they are unsure of the correct approach when confronting aggressive patients. |
| c. Lack of debriefing post C-ART call | Security | That would be the worst part of a C-ART call, we do not really get a debrief. | Opportunities to debrief after a C-ART call were found to be lacking. A debrief is a chance for the well-being of the C-ART members to be reviewed. |
| d. Poor communication and handover between medical teams | Doctor | I would say seventy-five percent, or eighty percent of times there are no clear plans from the treating team. | Communication regarding the management of patients who received a C-ART calls was at times poor, with no clear plans given to the after-hours doctor. Additionally, medical handover of the C-ART calls occurring after hours was also lacking. |
C-ART, Clinical Aggression Response Team.