Nonviolent Crisis Intervention Training and the Incidence of Violent Events in a Large Hospital Emergency Department

Abstract

Violence in hospitals complicates patient care. Emergency department settings (ED) pose significant risk for caregivers. Nonviolent crisis intervention (NCI) training was initiated to reduce the incidence of violence in an acute care hospital ED with more than 75,000 annual visitors. Training intended to build skills to defuse potentially violent situations and significantly decrease incidents in the ED requiring emergency security team involvement (manifested as code purples). A quantitative quality improvement study evaluated the training investment. The study collected ED code purple and staff training data from November 2012 to October 2013. Correlations were derived using Pearson's r. A regression model determined incremental training impact. There was a negative correlation between violence and NCI training in the previous 90-150 days; regression determined a 23% decrease in code purples, pursuant to training. Risk mitigation justified the facility's investment to continue NCI training. Training reinforcement at 6-month intervals shall be implemented for continued benefit.

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum

“…They worked with physician, nursing and hospital police educational leadership to ensure that our curricular content was in line with current best practices from the literature. 2 , 3 , 17 We used standardized participants (SPs) to maximize fidelity during case-based simulations that were designed to incorporate de-escalation and personal defense techniques, team-based interprofessional approaches, application of physical restraints and adjunctive medication route and dosing options.…”

“…14 , 15 Currently, educational strategies targeting WPV, including the widely adopted Nonviolent Crisis Intervention program from the Crisis Prevention Institute (CPI), have focused on an individual provider’s interaction with violent patients. 16 , 17 Healthcare simulation provides a realistic but safe venue to address issues surrounding patient violence. More importantly, simulation–based education can both directly influence participant attitudes and encourage interprofessional teamwork due to its inherent ability to impact learners’ cognitive frames and promote peer-to-peer dialog during structured debriefing.…”

The trouble with reporting and utilization of workplace violence data in health care

“…There is a need for improved reporting of workplace violence. Reporting is an accurate method of establishing the risk factors, extent, patterns, and contributing and precipitating factors associated with workplace violence (Gillam, ). Reporting enables staff to learn from incidents of workplace violence, including the evaluation of any interventions implemented (Brooks, Staniford, Dollard, & Wiseman, ).…”

Interventions for Workplace Violence Prevention in Emergency Departments: A Systematic Review

“…Table 2 provides an overview of the characteristics of the included studies. Of the fifteen studies, ten were conducted in the USA [14,[23][24][25][26][27][28][29][30][31], two in Australia [32,33], two in France [34,35] and one in Germany [36]. Five studies were published in each of the three time periods, from 2010 to 2013 [26,27,[32][33][34], from 2014 to 2017 [14,23,25,28,31], and from 2018 to 2021 [24,29,30,35,36], respectively.…”