Occupational Violence and Aggression in the Emergency Department

Mrs Sharon Klim1, Doctor Ainslie Senz1, Ms. Elisa Ilarda1, Professor Anne Maree Kelly1
1Western Health, St Albans, Australia

Background:  Violence in Emergency Departments (ED) is a significant problem world-wide.  Emergency settings are considered high risk areas with the number of incidents of staff exposure to violence ranging from 60 to 90% (Taylor and Rew, 2010). Despite some research being carried out in Emergency Departments few studies have evaluated the effectiveness of violence management and prevention strategies (Lau, Magarey and Cutcheon, 2005). Most research has focused on the rates of violence and the impact on staff.  There has been a significant gap in research studies so far, to provide a framework and practical interventions for guiding evidence based practice (Taylor and Rew, 2010).
Aim:  To review the outcome of implementation of the Bröset Violence Checklist (BVC); an evidence based violence risk assessment tool to the ED.
Methodology:  A two part study:

  1. A before-and-after survey; to assess changes to staff knowledge, attitudes, perceptions and confidence with respect to risk assessment for aggression/ violence.
  2. A before-and-after point prevalence data collection period; to compare risk assessment rating distribution between unstructured clinical assessment and the BVC.

Results: 76 Pre-implementation and 83 Post-implementation surveys completed.  In both surveys >70% of staff reported being subjected to verbal or physical aggression/violence and no change in confidence to prevent violence. However, there were statistically significant changes in the screening of patients for violence/ aggression risk, and improved confidence in staff ability to assess risk of violence and to identify risk factors. For the point prevalence component, in the pre-implementation cohort, 30% of patients underwent risk assessment (74/250). This increased to 82% after implementation (p<0.001). There was no difference in the distribution of assessed risk (low, moderate, high) after implementation with approximately 1% being assessed as high risk.
Conclusion: Occupational violence is common in ED. Prevention, including risk assessment, is a key strategy for mitigation. Using an assessment tool improves staff confidence in assessing risk, and provides a strategy for early identification and intervention. Reducing violence in all healthcare settings improves staff and patient safety and experience for all patients and visitors.

Sharon Klim is a research coordinator for the Joseph Epstein Centre for Emergency Medicine Research at Western Health. Sharon is also a Clinical Nurse Specialist in the Emergency Department at Footscray Hospital where her research knowledge and experience is often sought with assisting staff with quality improvement projects and other innovative ideas.  Sharon’s area of clinical expertise is clinical handover and leadership.