Retrospective Study of Perpetrators of Workplace Violence in a Large Urban Emergency Department in the United States

TL;DR

This study examines who commits workplace violence in a U.S. emergency department and finds that many perpetrators have a psychiatric history but aren't intoxicated or actively psychiatric at the time.

Contribution

The study provides new insights into the demographics and characteristics of perpetrators of workplace violence in emergency departments.

Findings

Half of perpetrators were not intoxicated or had active psychiatric complaints.

Physical violence was more common in patients on emergency detention.

Restraint use was associated with physical violence and active psychiatric or intoxication status.

Abstract

Background/Objectives: Data on the perpetrators of workplace violence (WPV) in healthcare settings are lacking. We sought to identify characteristics of perpetrators of WPV in a United States emergency department (ED) and explore associations between patient demographics and acute visit features. Methods: This is a retrospective descriptive study of the perpetrators of WPV against ED healthcare workers (HCWs) identified in a previous prospective study. Perpetrator demographics and visit features are described. Regression analyses were performed to assess for associations between perpetrator demographics and visit features with physical violence (PV) and restraint use. Results: 91 WPV encounters were included. The average age was 44.8 years. Most patients (n = 48; 53%) did not have an active psychiatric complaint and were not intoxicated, but 71 (78%) had a history of psychiatric illness. Twenty-four events (26%) involved PV, which was more common among patients on an emergency detention (RR 2.18; 95% CI 1.12–4.23) but was not associated with any patient demographics after adjustment. Restraints were ordered in 33 (36%) patients. Age, sex, PV, and intoxication or active psychiatric complaints were associated with restraint use, but in adjusted analysis, only PV (RR 1.89; 95% CI 1.13–3.16) and active psychiatric complaint or intoxication (RR 2.26; 95% CI 1.21–4.22) remained associated with restraint use. Conclusions: Half of perpetrators in this study were neither intoxicated nor had an active psychiatric complaint. PV was more common among patients on emergency detention. Restraint use was more likely in PV events and patients who were intoxicated or had psychiatric complaints.

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