Verbal and Non-Verbal Aggression in a Swiss University Emergency Room: A Descriptive Study.

Dominic Kaeser,Osnat Keidar,Rebekka Guerra,Michael Moses,Christian Kobel,Meret Ricklin,Aristomenis Exadaktylos,Urs Lanz

doi:10.3390/ijerph15071423

Abstract

Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of ED staff who experienced WPV over a 4-year period (2013–2016). We analyzed data on the reasons for the incident, the time of day, the manner of violence, the consequences, and the migratory background of the aggressor. In total, 83 cases of WPV were reported over a four-year period. The average age of the violent person was 33.1 years; in 35 cases (42.0%), aggressors were younger than 30 years old, 53 (63.8%) were male, 49 (59%) were of Swiss nationality, and 35–40% had a migratory background. The odds ratio of people originating from a low- to middle-income country versus those originating from a high-income country was 1.8. Furthermore, 45.8% of the patients arrived by ambulance (n = 38) and 19 patients (22.9%) were self-presenting. Most cases (92.8%) involved verbal aggression, but in more than half of the cases, physical assault (56.6%) was also reported. In addition, 43 (51.8%) of the events occurred during the night. Results also showed that 42 (50.6%) of patients who were involved in WPV were under the influence of alcohol and 29 (34.9%) suffered from psychiatric disorders. Security personnel and police were involved in 53 (63.9%) and 47 (56.6%) cases, respectively. Twenty patients (24.1%) were sedated and 16 (19.3%) were restrained. In 18 cases (21.7%), the psychiatrist ordered compulsory hospitalization in a psychiatric institution. Taken together, WPV is a relatively common event in our ED and persons with a migratory background are involved more often relative to their frequency of ED visits.

Highlights

Workplace violence (WPV) by patients and visitors is a reality in many emergency departments (ED) all over the world [1,2,3,4,5,6,7,8,9]
These include patient-related risk factors, such as social, economic and cultural factors, male gender, alcohol intoxication, substance abuse, mental disorder, and language barrier that leads to frustration [20,22,23,24]. These factors are often found in migrants, especially those who originate from low- and middle-income countries [25]. With these reasons and the recent increase of patients with migratory backgrounds seeking ED assistance, as well as previous reports indicating that migrants are prone to be at higher risk for aggressive behavior [26], the aim of this study was to define the incidence of and characterize cases of WPV that were reported at the ED of a Swiss university hospital
Found a similar trend, with 76.5% of cases of WPV from 17:00–08:00 [39]. These findings show that security personnel ought to be rapidly available at all times and especially during night shifts. In this single center study, we described the 4-year incidence of WPV in a Swiss university hospital

Summary

Introduction

Workplace violence (WPV) by patients and visitors is a reality in many emergency departments (ED) all over the world [1,2,3,4,5,6,7,8,9]. 81% of nurses experienced VA and 26% experienced PA over a one month period [10,11,12]. Rates of VA may be up to 100% within the last twelve months. Published data about WPV in the ED setting reports very different crime rates depending on the setting and location [13,14,15,16,17,18,19]. Public Health 2018, 15, 1423; doi:10.3390/ijerph15071423 www.mdpi.com/journal/ijerph

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