Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Violence against healthcare workers in the medical setting is common and associatedwith both physical and psychological adversity. The objective of this study was to identify featuresassociated with assailants to allow early identification of patients at risk for committing an assault inthe healthcare setting.

Methods: We used the hospital database for reporting assaults to identify cases from July 2011through June 2013. Medical records were reviewed for the assailant’s (patient’s) past medical andsocial history, primary medical complaints, ED diagnoses, medications prescribed, presence ofan involuntary psychiatric hold, prior assaultive behavior, history of reported illicit drug use, andfrequency of visits to same hospital requesting prescription for pain medications. We selectedmatched controls at random for comparison. The primary outcome measure(s) reported are featuresof patients committing an assault while undergoing medical or psychiatric treatment within themedical center.

Results: We identified 92 novel visits associated with an assault. History of an involuntarypsychiatric hold was noted in 52%, history of psychosis in 49%, a history of violence in the ED ona prior visit in 45%, aggression at index visit noted in the ED chart in 64%, an involuntary hold (orconsideration of) for danger to others in 61%, repeat visits for pain medication in 9%, and history ofillicit drug use in 33%. Compared with matched controls, all these factors were significantly different.

Conclusion: Patients with obvious risk factors for assault, such as history of assault, psychosis, andinvoluntary psychiatric holds, have a substantially greater chance of committing an assault in thehealthcare setting. These risk factors can easily be identified and greater security attention given tothe patient.