Prevalence of violence against health care workers among agitated patients in an urban emergency department.

Abstract

Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED. This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication. We collected detailed data for patients with agitation, defined as a score of +1 or higher using the altered mental status scale, an ordinal agitation scale from -4 (coma) to 0 (normal) to +4 (most agitated). Trained observers present in the ED 24/7 recorded whether each encounter involved verbal abuse, threat of violence, or a violent act against a health care worker. The primary outcome was the occurrence of assault as defined by state statute (threat of violence or violent act). We compare observed events to those formally reported to the hospital. From 17,873 encounters screened there were 4609 (25.8%) in which the patient had agitation. Alcohol or drug intoxication was present in 4108 (89.1%) encounters. The number of encounters with assault was 937 (20.3%, 95% confidence interval [CI] 19.1%-21.5%), which included 802 encounters (17.4%, 95% CI 16.3%-18.5%) with a threat of violence and 362 encounters (7.9%, 95% CI 7.1%-8.7%) with a violent act. Verbal abuse occurred in 1786 encounters (38.8%, 95% CI 37.3%-40.2%). Events were formally reported to the hospital in 9/1786 (0.5%) instances of verbal abuse and in 224/362 (61.9%) instances of a violent act. Verbal abuse, threats of assault, and violent acts occurred frequently in ED patients with agitation and were underreported.