The assessment and management of the violent patient in critical hospital settings

Patient violence and aggression is prevalent in critical care settings, yet clinicians are often inadequately trained to assess and respond to these types of behaviors. Targeted toward trainees as well as seasoned clinicians, this articles provides an updated review of the literature regarding the management of violence in the emergency department.

This narrative review is largely derived from research articles and reviews published since 2000. We conducted a systematic search of electronic databases for review articles or studies examining patient violence and aggression in critical care settings. Electronic searches were supplemented by manual searches of reference lists.

Current statistics, risk factors and imminent signs of violent patient behavior are presented. We conclude with recommendations for pharmacological and psychological interventions that can help manage aggressive behavior in the emergency department.

The relatively high frequency of aggressive and violent behavior in critical care settings increases the likelihood that clinicians working in this environment will encounter this situation. It is our hope that providing additional information about the factors associated with and techniques for managing violent patient behavior will reduce the occurrence of injuries in health care professionals in emergency departments.