Perpetrators of Workplace Violence in a Large, Urban Emergency Department

Data on the perpetrators of workplace violence (WPV) in healthcare settings is lacking. We sought to identify characteristics of perpetrators of WPV in the emergency department (ED) and explore associations between patient demographics and acute visit features with 1) WPV events that involved physical violence (PV), or 2) the use of restraints.

This is a retrospective descriptive study of the perpetrators of WPV against ED healthcare workers (HCWs) identified in a previous prospective study conducted at a large, urban hospital in the United States. WPV perpetrator demographics and visit features are described. We assessed features associated with PV and restraint use in univariate analyses and multivariable regression analyses to assess for significance of associations after adjustment for confounders.

Of the 91 WPV encounters included in this study, the patient was intoxicated in 34 (37%), had an active psychiatric complaint in 26 (29%), and had a history of psychiatric illness in 71 (78%). The gender and race of perpetrators of WPV in this study was similar to the overall ED population. The average age was 44.8 years. Most patients (n=48; 53%) did not have an active psychiatric complaint and were not intoxicated. Twenty-four events (26%) involved PV. PV was more common among patients on an emergency detention (RR 2.18; 95% CI 1.12–4.23), but this association was not statistically significant after adjustment for confounders. PV was not associated with age, sex, race, intoxication, or active psychiatric complaints. Restraints were ordered in 33 (36%) patients. Age, sex, physical violence, intoxication, and active psychiatric complaints were associated with restraint use, but after adjustment for confounders, only PV event (OR 4.13; 95% CI 1.35–12.62) and active psychiatric complaint or intoxication (OR 3.32; 95% CI 1.15–9.56) were independently associated with restraint use.

About half of the perpetrators in this study were neither intoxicated nor presenting with an active psychiatric complaint. PV was not associated with sex, race, intoxication, or active psychiatric complaints. Restraint use was more likely in PV events and patients who were intoxicated or had psychiatric complaints. This study increases understanding of the characteristics of perpetrators of WPV and can inform more targeted interventions to reduce WPV in the ED.