TOPLINE:
A study showed that more than 28% of patients who exhibited violent behavior continued exhibiting that violence in subsequent healthcare settings, often beginning out-of-hospital and continuing in the emergency department (ED) or hospital.
METHODOLOGY:
- Researchers conducted an observational cohort study to assess violence across multiple care settings at a large academic center from December 2022 to November 2023.
- Data were collected from emergency medical service (EMS), ED, hospital, and security records.
- The analysis included 4721 violent patient encounters (comprising 2791 distinct encounters from 2251 unique patients). Of these, 206 were out-of-hospital, 868 were ED, and 3561 were non-ED hospital violent encounters.
- The primary outcome was violent patient encounters, including verbal abuse, physical assault, and threats.
TAKEAWAY:
- Of the 2791 violent encounters, 28.1% continued into a second care setting, 12.6% into a third, and 7.5% into a fourth.
- Out-of-hospital settings had the highest rate of violence (18.02 events per 10 hours), followed by the ED (0.35 events per 10 patients); 41.7% of patients who were violent out-of-hospital were violent again in the hospital, with 26.2% specifically in the ED.
- Out-of-hospital violence occurred in 0.78 per 100 encounters, with ED violence at 1.06 per 100 encounters and non-ED hospital violence at 6.37 per 100 encounters.
- Patients aged 65 years or older had the lowest incidence of violence in the ED (3.7% vs 24.5%; relative risk [RR], 0.17; 95% CI, 0.13-0.23) and the highest on the general hospital floor (54.1% vs 21.1%; RR, 2.39; 95% CI, 1.37-2.49) compared with younger patients.
IN PRACTICE:
“Our findings reveal that workplace violence spans multiple care settings, beginning in the out-of-hospital setting, continuing through the ED, and persisting into inpatient units following admission,” the authors wrote, reflecting on the importance of exploring “contributing factors such as care transitions and underlying risk factors to inform targeted interventions aimed at preventing violence and safeguarding healthcare staff.”
SOURCE:
The study was led by Sarayna McGuire, MD, MS, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota. It was published online on June 18, 2025, in Annals of Emergency Medicine.
LIMITATIONS:
The study results may not be generalizable to patient populations in rural or community hospitals served by EMS agencies that are not affiliated with hospitals and may have limited application to populations other than non-Hispanic White individuals. Other limitations were the potential underreporting of violent events and lack of data on other types of workplace violence.
DISCLOSURES:
The authors reported no funding information or relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.