Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department

Background:Emergency department (ED) health care workers experience high rates of workplace violence (WPV).Local Problem:Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits.Methods:A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED.Interventions:Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies.Results:Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits.Conclusions:Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.