Preliminary risk assessment of workplace violence in hospital emergency departments

The risk assessment of workplace violence in emergency departments represents a global challenge for both healthcare organizations and workers. Recent studies have revealed increased rates of workplace violence towards physicians and nurses employed in emergency departments and have shown that type II is the most common typology of workplace violence among the four types of workplace violence defined by the National Institute for Occupational Safety and Health. The present study aimed to develop a methodological technique for a preliminary assessment of type II workplace violence risk in emergency departments.

The Delphi method was used to develop a questionnaire entitled Emergency Department Workplace Violence-Questionnaire which was composed of two sections: 1) sentinel events, and 2) risk factors. The authors used the Emergency Department Workplace Violence-Questionnaire to evaluate the workplace violence risk among physicians and nurses employed in a hospital emergency department.

The Emergency Department Workplace Violence-Questionnaire was composed of 21 items. The sentinel events section consisted of three company indicators related to workplace violence and identified three areas of risk. The risk factors section identified 18 organizational and environmental factors associated with workplace violence occurrence. The assessment of workplace violence risk in the targeted hospital emergency departments, obtained through the use of the Emergency Department Workplace Violence-Questionnaire, showed a medium risk of workplace violence for both physicians (score=18) and nurses (score=19.5); the analysis found objective risk factors associated with workplace violence and led us to suggest organizational and environmental interventions for reducing the sources of risk among healthcare workers and to prioritize the interventions targeted at the problematical issues detected by the Emergency Department Workplace Violence-Questionnaire. The corrective interventions were focused on an engineering level (i.e. absence of areas for patients/clients to de-escalate, absence of alarm systems) and regarding the organizational environment (i.e. absence of a Workplace Violence Task Force to assess workplace violence risk and develop solutions, working alone).

The proposed questionnaire proved to be a valid, structured, and reliable tool for assessing the risk of workplace violence in the targeted emergency departments and allowed for the identification of improvement actions targeted at specific critical issues which could be minimized through strategic interventions.