[Violent and aggressive behavior among patients in emergency wards]

The purpose of this investigation was to identify risk factors for violent and aggressive behaviour in patients in the Emergency Room (ER) with a view to suggesting prophylactic measures. From 1st December 1991 to 30th November 1992 all staff at the biggest ER in Denmark (Odense University Hospital) who had felt themselves exposed to aggressive or violent behaviour from patients answered a questionnaire about the incident. There were 47,013 contacts to the ER and 36 incidents involving violence or aggression towards hospital staff during the study period, corresponding to an incidence of 1/1306 patient contacts (0.08%), or one episode every ten days. In no cases did the violence result in staff injury requiring medical treatment, and there was only one case of dangerous violence (an aggressive patient threatened staff with a knife). The police were called in to assist in 50% of cases. Most (83%) of the incidents were caused by men. Seventy-five percent of the aggressive patients (including all six aggressive women) were easy to identify because they were visibly under the influence of either alcohol, narcotics of medications. Incidents occurred most commonly in the evenings, particularly weekends and holidays, which could possibly be associated with the general increase in alcohol consumption at these times. Long waiting-times were involved in 22% of the cases, and it is therefore proposed that waiting-times should be shortened by organizational changes. Review of the literature reveals that aggressive and assaultive behaviour is multifactorial, caused by a combination of personal and situational factors. Provoking factors in the ER environment are rarely recognized.(ABSTRACT TRUNCATED AT 250 WORDS)