Abstract
Background
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.
Objective
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: February 13, 2012
Accepted:
June 5,
2011
Received in revised form:
April 4,
2011
Received:
October 18,
2010
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
