Objective: In 2018, we developed and implemented a novel approach to recognition and response to occupational violence and aggression (OVA). It included routine use of the Brøset Violence Checklist for all ED patients integrated with a scorebased notification and response framework. The present study evaluated the impact of the new process on staff knowledge, perceptions and confidence regarding OVA in ED and the rate of security events related to OVA. Methods: The present study was conducted in a metropolitan hospital ED in Australia. Evaluation was by online before and after survey of nursing staff, point prevalence study of risk classification and comparison of OVA-related events involving security in the year before implementation and the year after the programme was embedded. Results: One percent of patients were assessed as high violence risk with a further 4% at moderate risk. The introduction of the Brøset Violence Checklist increased documentation of violence risk assessment. It also improved staff perception of organisational support and awareness of behaviours associated with the risk of violence. There was a statistically significant reduction in unplanned OVA-related security responses (relative risk 0.75, 95% confidence interval 0.62-0.89). There was also a statistically significant shift to proactive management through early detection and intervention (relative risk 2.22, 95% confidence interval 1.85-2.66). Conclusion:A process including routine OVA risk assessment and a notification and response framework reduced unplanned security events due to OVA and increased staff confidence in recognition and management of OVA. This approach may be suitable for use more broadly in ED.

In reference to the recent work on understanding economic evaluation alongside emergency medicine research by Singh et al 1 , we would like to draw attention to the selection of the discount rate when performing an economic analysis. This choice has implications in that a figure in the lower ranges may overestimate the value of an outcome or the cost of an intervention or project. A higher rate may result in less promising results and may even be enough to send a potential capital investment's Net Present Value into the negative.There are three different options to selecting an appropriate discount rate, depending on what the aim of the calculations are.

The present study is one of the first to investigate the role of emotional intelligence in the predilection for teamwork. One hundred and thirty-four respondents, all working in teams, were administered Palmer and Stough's ( 2001) measure of emotional intelligence, the NEO-FFI and the Team Player Inventory (Kline, 1999). In line with expectations, the strongest correlations with teamwork were found to be with extraversion, total emotional intelligence and agreeableness. Neuroticism correlated negatively with teamwork and no relationship was found between conscientiousness and predilection for teamwork. Additionally, this research challenged the argument that emotional intelligence is little more than personality by showing that the construct of emotional intelligence added predictive power to that of personality. Limitations and implications for future research are also discussed.