Implementation of “STAMP” at Triage to Prevent Workplace Violence in the Emergency Department: A Quality Improvement Project

Abstract

Introduction

Workplace violence (WPV) is a significant concern in healthcare settings, especially in the Emergency Department (ED). Early identification of patients at risk for violent behavior is critical to WPV prevention and staff safety. The STAMP tool—Staring, Tone, Anxiety, Mumbling, and Pacing—is uniquely designed for the ED and guides clinicians in assessing behavioral cues associated with potential for violence. This project aimed to decrease staff injuries by implementing the STAMP tool at triage.

Methods

The STAMP tool was piloted in the triage of three urban emergency departments in the Southeastern U.S. Project outcomes included WPV-related staff injuries, tracked for two years before and after STAMP implementation. Additional measures included usability and satisfaction evaluated through surveys and focus group interviews with triage nurses, along with documentation rates of STAMP. Descriptive statistics and independent t-tests were used to analyze the data.

Results

Implementation of the STAMP tool was associated with a significant reduction in WPV-related staff injuries (t(46) = 4.45, p < .001, CI 0.66–1.76). The average usability score for STAMP was 81.5 (SD ± 12.3), with 65% of triage nurses rating usability above average (n = 13/20). 90% of nurses (n = 18/20) found the tool helpful, and 65% (n = 13/20) reported feeling safer at work following implementation. Documentation rates for STAMP surpassed 90% by Week 9 and averaged 88.97% throughout the two-year study period.

Discussion

The STAMP tool is an easily adopted and sustainable tool for early detection and prevention of WPV in the ED. With effective implementation into the triage workflow, STAMP is associated with significant harm reduction, improved communication, high usability, and consistent documentation, supporting its potential for effective prevention of WPV in the ED.