Medley Dylan B, Morris James E, Stone C Keith, Song Juhee, Delmas Thomas, Thakrar Kunal
Department of Emergency Medicine, Scott and White Hospital, Temple, Texas 76508, USA.
J Emerg Med. 2012 Oct;43(4):736-44. doi: 10.1016/j.jemermed.2011.06.131. Epub 2012 Feb 9.
Studies have explored possible causes of violent acts in the emergency department (ED), however, the association of violence with ED crowding has not been studied. Although the total number of violent acts would be expected to increase, it is not clear if the rate of violent acts also increases as occupancy levels rise.
The purpose of this study was to determine if there is an association between occupancy rates in the ED and rates of violence toward staff.
This was a retrospective chart review study. Violent incidents in a community, Level I trauma center ED were identified from review of orders of emergency detainment, adverse event forms, physical restraint logs, and pharmacy records from January 1, 2005 to June 1, 2008. Occupancy rates for all days were calculated and violent vs. non-violent days were compared using a standard two-sample t-test. Logistic regression analysis was then used to investigate other factors associated with violent incidents.
A rate of violence of 1.3 incidents per 1000 patients was found. When comparing the occupancy rates of violent days (mean 95%, SD 26%) with non-violent days (mean 86%, SD 24%), a statistically significant association was found (p<0.0001). Multivariate logistic regression confirmed a significant association between crowding and violence toward staff (odds ratio 4.290, 95% confidence interval 2.137-8.612).
These results suggest another possible negative effect that crowding has on ED staff and physicians. Policies and recommendations regarding ED operating procedures and staff safety during times of higher occupancy levels should be discussed.
已有研究探讨了急诊科暴力行为的可能成因，然而，暴力行为与急诊科拥挤之间的关联尚未得到研究。尽管暴力行为的总数预计会增加，但尚不清楚随着占用水平的上升，暴力行为的发生率是否也会增加。
本研究的目的是确定急诊科的占用率与针对工作人员的暴力发生率之间是否存在关联。
这是一项回顾性图表审查研究。通过审查2005年1月1日至2008年6月1日期间的紧急拘留令、不良事件表格、身体约束记录和药房记录，确定了一家社区一级创伤中心急诊科的暴力事件。计算所有日期的占用率，并使用标准的双样本t检验比较暴力日与非暴力日。然后使用逻辑回归分析来研究与暴力事件相关的其他因素。
发现暴力发生率为每1000名患者1.3起事件。在比较暴力日（平均95%，标准差26%）与非暴力日（平均86%，标准差24%）的占用率时，发现了具有统计学意义的关联（p<0.0001）。多变量逻辑回归证实了拥挤与针对工作人员的暴力之间存在显著关联（优势比4.290，95%置信区间2.137 - 8.612）。
这些结果表明拥挤对急诊科工作人员和医生可能产生的另一种负面影响。应讨论关于急诊科操作程序以及占用率较高时工作人员安全的政策和建议。
