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.