Developing and Testing a Multimodal Intervention to Decrease Violence and Increase Perceptions of Safety in the Emergency Department: A Longitudinal Study.

Introduction: Patient and visitor violence and aggression against emergency department clinicians is a complex phenomenon requiring a multifaceted approach and recognition that interventions require time to integrate into practice. The purpose of this study was to determine the efficacy of a multimodal intervention on frequency of workplace violence incidents and clinicians' perceptions of safety in one emergency department.

Methods: A quasi-experimental, longitudinal design was used to answer study questions. Environmental changes, an algorithmic response guideline that included a rapid de-escalation program, and improvements in the formal incident reporting system were implemented. Participants completed an online, anonymous survey that included demographic information, the Personal Workplace Safety Instrument for Emergency Nurses, and a violence and aggression frequency checklist prior to and for three quarters following implementation.

Results: Surveys were sent to all 140 emergency department clinicians. Response rate was highest at baseline but decreased over time. There was no significant difference in number of incidents experienced by clinicians during the study. Perceptions of safety decreased from baseline during the course of the study, but there was a significant increase in the number of formal incident reports submitted.

Discussion: Despite significant efforts, it was difficult to decrease violent and aggressive acts committed by patients and visitors and to improve emergency department clinicians' perceptions of safety in the emergency department. Timing and severity of violent and aggressive acts may have influenced results. More work needs to be done using different research, implementation, and evaluation methods to determine best practices for preventing WPV in the emergency department.