Use of a Violence Risk Assessment Tool in an Acute Care Hospital

Abstract

This study examined the use and effectiveness of the Alert assessment form. The form is part of the Alert system, used by one large acute care hospital to identify patients with a propensity for violence. All reported incidents of patient violence from August 1, 2003, through December 31, 2004, were included in patient charts. One hundred seventeen violent patient charts were reviewed and compared with 161 non-violent patient charts, randomly chosen from the same time period. Overall use of the Alert assessment form for violent and non-violent patients was 75.7% and 35.4%, respectively. The assessment form was found to have moderate sensitivity (71%) and high specificity (94%). It is reasonably effective in identifying potentially violent or aggressive patients when it is used according to protocol. Efforts to improve the tool are warranted, as is evaluation of its benefit in settings with low prevalence of violence. Also, greater effort must be taken to prevent violence once an aggressive patient has been identified.

A confirmatory study of Violence Risk Assessment Tool (M55) and demographic predictors of patient violence

“…The results of the current study are in conflict with the previously reported sensitivity of 71% obtained through retrospective chart review (Kling et al. 2006).…”

“…The M55 is composed of the potential risk factors that were used as the alert assessment form in a general acute care setting (Kling et al. 2006).…”

Worksite Walkthrough Intervention

“…The authors suggested that further research should focus on “objective observation of actual events and a detailed documentation of the nature of the events, the nature of the offenders, and the staff responses” 12 (p.53), which is the foundation of the current study. Kling et al 13 implemented a program known as the Alert System, 14 which flags patients likely to become aggressive based on a short assessment conducted during their admission. That study focused on Type II (patient-to-worker) violence, and used rates of workplace violence based on patient incident reports and number of hours worked.…”

Integrating DSM‐IV Factors to Predict Violence in High‐Risk Psychiatric Patients

“…The review of current studies reveals complexities in study design and outcome data. Some studies excluded either Axis‐I, Axis‐II, or Axis‐IV risk factors in DSM‐IV, focused on subjective self‐reports, used complex instruments, and were hampered by incomplete data collection (29,30). Dementia was shown to pose an independent high risk for violence.…”

“…In constructing the ROVA scale, we applied key elements integrated from research: (i) optimize objectivity during data collection; (ii) establish standardized, operational definitions for each predictor variable; (iii) clarify what to observe and what to measure; (iv) implement a standardized summative scale of predictor variables; (v) define categories of risk from low to high; and (vi) develop a data collection tool to document actual violence during hospitalization (19,29,35,36). …”