How Do Weapons Screening Programs Reduce Armed Hospital Assault? A Scoping Review of Public Health Principles.

Abstract

Purpose: Healthcare organizations are increasingly piloting weapons screening programs (WSPs) like metal detectors (MDs) to combat rising hospital workplace violence (WPV). This study identifies, analyzes, and concisely reports how the extant body of literature supports the ability of WSPs' to reduce absolute rates of hospital WPV according to public health principles.

Methods: We searched six online databases from July 2023 to December 2024 for full-length papers and abstracts of original research regarding WSPs at public entrances to US hospitals. Study quality and robustness were assessed using the Mixed Methods Appraisal Tool and the 2010 Melnyk and Fineout-Overholt hierarchy of evidence, respectively.

Results: A total of 29 studies were included, and all were nonexperimental designs from academic institutions. Twenty-eight (96.6%) were quantitative descriptive studies, and one was qualitative. All studies ranked within the second lowest tier of experimental robustness with an average quality score of 85.5%. Only two studies directly measured absolute rates of hospital WPV before and after WSP implementation; neither demonstrated objectively lowered rates of WPV. Studies concluding efficacy of WSPs to lower rates of armed hospital WPV are steeped in circular feedback loops anchored in type 1 pseudodisease estimates of prevalence and efficacy where weapons presence is taken for prevalence of armed assault, and weapons removal is taken for reduction of armed assault. Proxy measurements like favorable public opinions and popularity of WSP practice secondarily reinforce extant literatures' conclusions of WSP efficacy.

Conclusions: We found no direct evidence that WSPs reduce absolute rates of hospital WPV based on public health principles. The results of our scoping review by no means suggest that armed WPV is an acceptable or negligible risk to hospital patients and providers. Rather, the low baseline prevalence of armed WPV suggests that even if WSPs were supremely reliable at stopping armed perpetrators with criminal intent, overall rates of hospital WPV would still climb because WSPs do not intervene upon the unarmed preponderance of hospital WPV and may inadvertently divert financial resources needed to improve the clinical factors driving those risks.