Violence in the Accident and Emergency Department

Abstract

Crimes of violence are recorded increasingly frequently, including those involving health professionals. We reviewed records of violent incidents kept for a major Accident and Emergency Department over a ten-year period. Details were recorded in a Violent Incident Book by all grades of A/E staff, and separate records were kept by hospital security officers. A total of 407 incidents were recorded. Numbers, rank and sex of staff assaulted, types of assault, injuries received, weapons used and characteristics and disposal of perpetrators were recorded. Many were young males who had been drinking: others were regular attenders, of whom three subsequently died and one convicted of murder. Nurses and male doctors appeared to be at the greatest risk of assault and receptionists at the least risk. Recording of violent incidents and subsequent prosecution seemed inconsistent, and may have reflected the lack of a code of practice in this area. Suggestions are made about preventing, predicting and dealing with violence, and its aftermath, in the A and E department, including the use of security officers and closed circuit television, waiting room design, the recognition of body language and signs of alcohol or substance intoxication. The importance of staff support after an assault is emphasized, including immediate and long-term counselling, provision of legal advice, criminal or civil court action, victim support schemes and the workings of the Criminal Injuries Compensation Board. Free legal advice for staff assaulted at work should be included in the terms of service of NHS staff.

Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland.

“…Patients and their relatives, who seem quite prepared to be rude and often offensive to nurses, are usually much less aggressive when the doctor arrives. 4 Episodes of physical attack are perhaps more spontaneous and more likely to involve medical staff, although nurses are still more often affected. This is probably because of the physical nearness nurses and doctors have to patients, whereas receptionists are often protected from physical attack, but not from verbal abuse, by glass screens.…”

Managing alcohol related aggression in the emergency department (Part I)

“…Within the researching of violence and aggression in the health care environment studies have traditionally identified the demographics of service users who have been involved in aggressive confrontations with staff emphasising variables such as a previous history of violence (Knott et al, 2005), a psychiatric presentation (Crilly et al, 2004), alcohol and substance abuse (Jenkins et al, 1998), affiliation with street gang activity/ criminality, (Keep and Glibert, 1995) and male gender and young age, (Morgan and Steedman, 1985;Cembrowicz and Shepherd, 1992). However, Rippon (2000) concluded that in comparison with some other professions, little empirical research has been conducted within health care workplaces into incidents of aggression and violence and from a broader perspective researchers are increasingly drawing on the importance of situational factors that influence the development of violent and aggressive interactions between staff and service users.…”

Evidence-based treatment of psychiatric patient

“…The number of psychiatric patients who present with assaultive behavior at psychiatric facilities has been found in observational studies to be 4 -60% (level II) (2)(3)(4)(5)(6)(7)(8). The number of actual violent episodes in EDs has been studied in Britain but has not been well studied in the United States.…”

“…The number of actual violent episodes in EDs has been studied in Britain but has not been well studied in the United States. British studies have reported violent episodes at a rate of 2% on a daily basis and 12% on a weekly basis in accident and emergency departments (level II) (2,3). A survey study of ED medical directors found that a number of EDs have violence problems (level II) (4).…”