Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

Abstract

Objective and settingPrimary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.InterventionThe programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.ParticipantsAll patients admitted to the OED and those accompanying them.DesignSingle-centre prospective interrupted time-series study conducted over 18 months.Primary outcomeViolent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.Secondary outcomesWaiting time and length of stay.ResultsThere were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.ConclusionA comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.Trial registration numberNCT02015884

An integrative review of waiting time, queuing, and design as contributory factors to emergency department violence

“…Of note Bayram et al 39 observed that ED doctors responses seemed to indicate that the type of hospital was influential in ED violence with it being more common in public, rather than private, hospitals. ED over crowdedness 27,29,31,40 and waiting times 27,29,30,41,42 emerged as key contributory factors to ED violence. Indeed Efrat-Treister et al 40 found that crowdedness was associated with a greater number of violent attacks.…”

“…One such study observed a reduction in ED violence was with the use of a specifically designed ED intervention programme. 42 This was designed to address long waiting times and provide more transparent and visible information to patients and attendees. It combined a computerized triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the ED, educational messages broadcast in the waiting room.…”

Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study

“…29 30 A previous multicomponent programme conducted in an emergency unit has shown the potential interest of a mediator in response to situations of violence. 31 Before setting up a mediation intervention, it is necessary to study the experiences about violence among the professionals who will be in contact with the mediators. Knowing these experiences makes it possible to adapt the mediation interventions to the difficulties and strategies already implemented by the professionals.…”

Effectiveness of interventions for the prevention of occupational violence against professionals in health services: a protocol for a systematic review

“…16 Another study evaluated an electronic program addressing an algorithm of the waiting time of patients at a university hospital and noted a decrease in the incidence rate of violence among the health team. 17 Systematic reviews 18 19 have also sought to answer the question of the effectiveness of interventions carried out to prevent violence against health workers; however, authors 18 19 have found low to moderate evidence regarding prevention programs carried out in emergency departments. One study 18 evaluated the evidence according to the classification proposed by Oxford, 20 and another study 19 evaluated the evidence but did not present the tools used for the measurement.…”

“… 16 Another study evaluated an electronic program addressing an algorithm of the waiting time of patients at a university hospital and noted a decrease in the incidence rate of violence among the health team. 17 …”