# Enough is enough: Alcohol‐related occupational violence and aggression in emergency departments in Australia and New Zealand

## TL;DR

Emergency department staff in Australia and New Zealand frequently face alcohol-related violence, which is increasing and negatively impacts patient care and staff well-being.

## Contribution

This study quantifies the rising prevalence and impact of alcohol-related occupational violence in emergency departments across Australia and New Zealand.

## Key findings

- Almost all ED staff experienced verbal aggression and most experienced physical aggression from alcohol-affected patients.
- Alcohol-related violence negatively impacts patient wait times, care quality, and staff wellness.
- Two-thirds of staff believe alcohol-related violence has worsened over the past five years.

## Abstract

To determine the extent of alcohol‐related violence in EDs throughout Australia and New Zealand and the impact this has had on ED staff.

A mixed methods, cross‐sectional, online survey of ED staff working in Australia and New Zealand conducted between 1 August and 11 September 2022 measuring the frequency of physical or verbal alcohol‐related aggression from patients and their relatives/carers; changes to the frequency of alcohol‐related occupational violence over the preceding 5 years; the impact of COVID‐19 on these presentations; and the perceived impact on ED function and staff well‐being.

A total of 1284 ED staff responded, with almost all (97.9%) reporting having experienced verbal aggression and 92.7% experienced physical aggression from alcohol‐affected patients at some point over the preceding 12 months. Alcohol‐related presentations were significantly associated with negatively impacting patient wait times (86.1%), the care of other patients (87.5%) and other patients in the waiting room (94.6%). A large majority of ED staff also noted that these presentations negatively impacted staff wellness (82.4%), workload (93.1%) and job satisfaction (78.9%). Most (68.2%) believed that the issue of alcohol‐related violence had worsened over the preceding 5 years and 46.7% believed that COVID‐19 specifically has worsened the incidence of alcohol‐related violence in the ED.

Alcohol‐related occupational violence and aggression is experienced by almost all ED staff and the prevalence is perceived to be increasing. It results in negative impacts on both staff well‐being, the care of other patients and ED function.

Levels of alcohol‐related occupational violence and aggression (OVA) in EDs remain unacceptably high: two‐thirds of ED staff surveyed believed alcohol‐related OVA has worsened over the last 5 years; almost all had experienced verbal aggression; and almost half suffered physical violence weekly or monthly. Evidence‐based policies for alcohol‐related patient management are required.