Increasing workplace violence in an Australian adult emergency department

Workplace violence (WPV) is an increasingly concerning occupational hazard within the ED. The aim of the present study was to evaluate the incidence and characteristics of WPV in an adult ED.

A retrospective cohort study was conducted to identify the incidence of ED WPV in an adult metropolitan ED. Data were obtained from the activity records of security staff from 1 January 2013 to 31 December 2015 for all incidents of patient-perpetrated violence. Data on patients identified from these records as requiring security staff intervention for violence in the ED were collected through an explicit chart review. Data on patient illicit drug or alcohol exposure and acute psychiatric diagnoses were also collected.

There were 1853 episodes of patient-perpetrated WPV identified over the study period. The incidence of WPV over the 3 years was 103 (95% CI: 98-108) per 10 000 of the presenting population, with a significant increase from 2013 to 2015 (IRR 1.07; 95% CI: 1.04-1.10; P < 0.01). Drug and/or alcohol exposure was observed in 1145 (61.8%) patients. Among the drug- and/or alcohol-affected violent population, three quarters (840/1145 = 73.4%) did not have a concurrent psychiatric diagnosis that required assessment during the violent presentation.

The rate of WPV was increasing within this Australian ED during the study period. The majority of violent patients were affected by drugs and/or alcohol in the absence of a psychiatric diagnosis. Interventions to reduce access to and misuse of alcohol and illicit drugs could have a substantial impact on the concerning increase of violence in the ED.