Characteristics of Violence Against Health Care Workers in an Urban Emergency Department

Violence against healthcare workers is an increasingly prevalent issue, notably in emergency departments. Healthcare workers (HCW), on average, experience violence once every 3.7 shifts, which often goes unreported. This study sought to evaluate the characteristics of violence that occurred in an urban emergency department and the occurrence of unreported violence.

This was a single-center, observational study conducted from June 2024 to August 2025 at an urban emergency department. Data were collected by trained research staff who were present 24 hours per day. Patients were screened, and detailed data were prospectively collected for all patients who had agitation during the ED encounter, defined as a RASS score greater than or equal to 1. The outcomes were verbal abuse and physical violence. Data were analyzed using GraphPad Prism v 10.6.1.

Of 8,967 patient encounters screened, 2,185 (24.4%) met enrollment criteria. The average age of individuals included was 42.1 (± 14.1), 1,447 (66.2%) were male. The median highest recorded RASS within 5 minutes of ED arrival was 1. The most common etiology of agitation was alcohol intoxication (n = 1067, 48.8%), followed by illicit drug use (n = 466, 21.3%), and decompensated psychiatric illness (n = 341, 15.6%). There were 770 instances of verbal violence (35.2%) of which 697 (90.5%) went unreported. There were 214 instances of threats of physical violence (9.8%) of which 182 (85%) went unreported. Finally, there were 172 (7.9%) instances of physical assault, of which 129 (75%) went unreported.

Agitation is common in the emergency department, frequently results in verbal abuse, threats of physical violence, or physical assault, and often goes unreported by healthcare workers.