Kim Son Chae, Kaiser Jennifer, Hosford Tracy, Sadate-Akhavi Carol, Nurski Ashleigh, Bos Thomas, Ciampa Chelsea
School of Nursing Point Loma Nazarene University San Diego California USA.
Corewell Health Grand Rapids Michigan USA.
J Am Coll Emerg Physicians Open. 2024 Jul 25;5(4):e13206. doi: 10.1002/emp2.13206. eCollection 2024 Aug.
Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool.
A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed.
Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; = 0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; = 0.418).
The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.
针对潜在暴力患者采取积极的缓解措施，可预防急诊科的患者暴力行为。我们旨在评估两种由经过验证的风险评估工具指导的干预措施的效果。
对2022年10月至2023年8月期间在美国密歇根州两家急诊科就诊的10岁及以上患者进行了一项前瞻性干预研究。在分诊期间，急诊科护士完成了急诊科攻击行为风险评估工具（ABRAT-ED），以识别高危患者。在基线观察期之后，对高危患者逐步实施干预措施：第1阶段张贴标识，第2阶段在张贴标识的基础上增加积极的行为应急反应团队（BERT）碰头会。在急诊科处置之前，记录任何暴力事件及其严重程度。研究完成后，对数据进行回顾性检索。
在77424名可评估患者中，546人发生了≥1次暴力事件。基线期、第1阶段和第2阶段的暴力事件发生率分别为0.93%、0.68%和0.62%。与基线期相比，第1阶段暴力事件的相对风险为0.73（95%置信区间[CI]：0.59‒0.90；P = 0.003）。与第1阶段相比，第2阶段的相对风险为0.92（95%CI：0.76‒1.12；P = 0.418）。
使用张贴标识作为ABRAT-ED识别出的高危患者的持续视觉提示，似乎可有效降低总体暴力事件发生率。然而，与单独张贴标识相比，在张贴标识的基础上增加积极的BERT碰头会并未显著降低暴力事件发生率。
