Seclusion Rates and Workplace Violence on a Psychiatric Emergency Department Unit

Actions of physical violence, harassment, or other threatening and intimidating behavior characterize workplace violence, often subsequently followed by seclusion to maintain safety in emergency department (ED) and psychiatric settings. Though there is no universally identified benchmark of acceptable rates of seclusion, April to September 2023 preintervention rate of seclusion hours on a psychiatric ED unit at a public state hospital in the southeast was 5.57/1,000 patient care hours, exceeding current comparison data from Centers for Medicare and Medicaid Services (CMS) for calendar year 2022 with a state average, 0.26/1,000 patient care hours and national average, 0.35/1,000 patient care hours.

This project aimed to reduce seclusion rates through the implementation of a violence risk identification and management protocol.

Interventions included brief training and implementation of a violence risk protocol using the Violence Assessment Tool (VAT) and seclusion debriefing.

Reports of workplace violence decreased by 25% in the psychiatric ED and 17% across the adult psychiatric inpatient units, and there was a cumulative decrease in Inpatient Psychiatric Facility Quality Reporting seclusion rates by 5% across the adult psychiatric inpatient units where the components of the VAT were communicated in report from the psychiatric ED.

Early identification of violence risk, patient-specific agitation factors, and de-escalation preferences in the ED setting may have the potential to improve safety through reduced seclusion and workplace violence events. Future research could study patient perspectives of the VAT as a patient-centered tool in de-escalation to reduce seclusion.