Interventions to Address and Prevent Violence Toward Health Care Workers in the Emergency Department

ABSTRACT

According to the International Labour Organization, workplace violence (WPV) is defined as "Any action, incident or behaviour that departs from reasonable conduct in which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work."1 Prevalence of WPV in the health care setting is increasing and has detrimental consequences for the health care worker (HCW), the patient and the organization.2 Workplace violence in the ED perpetrated by patients and visitors is a serious problem. EDs are considered high-risk areas with incidences of violence against HCWs reported to range between 60% and 90%.3 Although WPV frequently occurs in the ED, few affected individuals report it, and fewer seek help.4 , 5 Causes of violence and aggression can vary and are not always clear. Common causes of aggression and violence include distress and frustration, physiologic imbalances, substance misuse and abuse, intoxication, and mental health issues.6 WPV may result in physical injuries and mental stress to the HCW, which could lead to staff absenteeism, staff turnover, decreased productivity, and compromised care.2 Additionally, ED violence has financial implications for the health care system. In Ontario, ED violence is associated with costs of $23.8 million annually.4 For the prevention of violence experienced by HCWs in the ED, various interventions have been implemented;these include education and training programs, various pharmacological interventions, and physical restraint procedures. Violence toward HCWs in the ED is a longstanding problem that has reportedly worsened during the COVID-19 pandemic.7 The evidence regarding interventions for prevention of violence toward HCWs in the ED is needed to make informed decisions regarding implementation of preventive measures. The purpose of this report is to review the evidence regarding the clinical effectiveness of interventions to address and prevent violence and harassment toward HCWs in the ED, and additionally, to review the evidence-based guidelines regarding interventions to address and prevent violence and harassment toward HCWs in the ED.