Patient Agitation on Arrival to the Emergency Department Associated With an Increased Risk of Violence Against Health Care Workers

Patient agitation on arrival to the emergency department (ED) poses risks for patient and clinician safety alike. We sought to understand how initial patient agitation was associated with the prevalence of violence against healthcare workers during the ED encounter.

This was a single center, prospective, observational study conducted in an urban emergency department between June 2024 and August 2025. Trained research staff were present 24 hours per day in a locked unit embedded in the ED. Staff recorded the highest Richmond Agitation-Sedation Scale (RASS) scores within 5 minutes of patient arrival and whether they performed verbal abuse or violence. Data were analyzed using GraphPad Prism v 10.6.1.

A total of 8967 patient encounters were captured and a total of 8740 had initial RASS scores. Median highest RASS score within 5 minutes of ED arrival was 0 (95% CI 0-0). Simple logistic regression of highest RASS score within 5 minutes of ED arrival demonstrated a statistically significant association with acts of verbal abuse (OR 2.21; 95% CI 2.07 - 2.36), threats of physical violence (OR 2.25; 95% CI 2.04 - 2.47), and actual physical violence (OR 2.31; 95% CI 2.08 - 2.56).

Increased patient agitation on arrival to the emergency department is associated with an increased risk of verbal abuse, threats of physical violence, and physical assault. Thus, indicating the usefulness of RASS scoring when triaging patients’ risk of committing violence against healthcare workers.