Interventions to prevent aggression against doctors: a systematic review

Abstract

ObjectiveTo find out if there is evidence on interventions to prevent aggression against doctors.DesignThis systematic review searched the literature and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesPubmed, Embase, Turning Research into Practice (TRIP), Cochrane and Psycharticle, GoogleScholar andwww.guideline.govwere consulted.Eligibility criteriaAbstracts published in English between January 2000 and January 2018 were screened. Eligible studies focused on prevention and risk factors of type II workplace violence in general healthcare, psychiatric departments, emergency departments, emergency primary care, general practice.Data extraction and synthesisThe selected intervention studies were grouped into quantitative and qualitative studies. Systematic reviews were reported separately. For each study, the design, type of intervention and key findings were analysed. Quality rating was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQUAL).Results44 studies are included. One randomised controlled trial (RCT) provided moderate evidence that a violence prevention programme was effective in decreasing risks of violence. Major risk factors are long waiting times, discrepancy between patients’ expectations and services, substance abuse by the patient and psychiatric conditions. Appropriate workplace design and policies aim to reduce risk factors but there is no hard evidence on the effectiveness. One RCT provided evidence that a patient risk assessment combined with tailored actions decreased severe aggression events in psychiatric wards. Applying de-escalation techniques during an aggressive event is highly recommended. Postincident reporting followed by root cause analysis of the incident provides the basic input for review and optimisation of violence prevention programmes.ConclusionsThis review documented interventions to prevent and de-escalate aggression against doctors. Aggression against physicians is a serious occupational hazard. There is moderate evidence that an integrated violence prevention programme decreases the risks of patient-to-worker violence. The review failed to gather sufficient numerical data to perform a meta-analysis. A large-scale cohort study would add to a better understanding of the effectiveness of interventions.

Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences

“…Importantly, evidence on the efficacy of interventions to prevent aggression against doctors is lacking, and a systematic review and meta-analysis found that only few studies have provided such evidence (29). Just one randomized controlled trial indicated that a violence prevention program decreased the risks of patient-to-worker violence and of related injury in hospitals (30), whereas contrasting results in violence rates after implementation of workplace violence prevention programs have been observed from longitudinal studies (29). There is no evidence on the effectiveness of good place design and work policies aimed to reduce long waiting times or crowding in waiting areas (29).…”

“…Just one randomized controlled trial indicated that a violence prevention program decreased the risks of patient-to-worker violence and of related injury in hospitals (30), whereas contrasting results in violence rates after implementation of workplace violence prevention programs have been observed from longitudinal studies (29). There is no evidence on the effectiveness of good place design and work policies aimed to reduce long waiting times or crowding in waiting areas (29). More studies are clearly needed to provide evidence-based recommendations, and interdisciplinary research with the involvement of anthropologists, sociologists, and psychologists should be encouraged.…”

Workplace violence toward resident doctors in public hospitals of Syria: prevalence, psychological impact, and prevention strategies: a cross-sectional study

“…One study showed that such programs have measurable outcomes for a less violent workplace environment and better awareness of how to deal with aggressors [ 50 ]. In addition, training in conflict management, communication skills, and de-escalating during an aggressive event is strongly recommended and need to be integrated in a structured violence prevention program, as reported in a systematic review [ 51 ].…”

Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study

“…De-escalation is a highly specialised intervention and this might explain the limited effectiveness of the training programmes. 47 …”