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Promoting the health of healthcare workers : evaluating patient violence in healthcare Kling, Rakel Nessa

Abstract

Introduction: The high rate of violence in the healthcare sector supports the need for greater prevention efforts. This study had two main objectives: 1) identify risk factors for violence province- wide and 2) investigate the effectiveness of a violence risk assessment system in reducing the risk of violence in an acute care hospital in British Columbia. Methods: Study 1: Data was extracted for a one-year period from the Workplace Health Indicator Tracking and Evaluation (WHITE ™) database for all employee reports of violent incidents for four of the six British Columbia Health Authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, and by regression models. Study 2: Hospital violence incident rates (number of incidents/ 100,000 worked hours)were calculated pre, during and post implementation of the Alert System, a violence risk assessment system, at one acute care hospital. Then, using a retrospective case control study design, multivariable conditional logistic regression was used to model the effect of the Alert System (flag status yes or no) on the risk of a patient violent incident. Results: Study 1: Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities, the care aide occupation, and pediatric departments in acute care hospitals. Study 2: The violent incident rate decreased during the Alert System implementation period, but subsequently returned to pre-implementation levels. In the case-control analyses, patients flagged for violence were associated with an increased rather than decreased risk for violence. Conclusions: Study 1: The specific risk factors that put health care groups at an increased risk of violence should be examined so that targeted prevention or intervention efforts can be implemented. The identification of high-risk groups supports the importance of a province-wide surveillance system. Study 2: Although useful at identifying violent patients, the Alert System does not appear to provide the resources or procedures needed by health care workers to prevent a patient from progressing to a violent incident once flagged. These studies suggest that violence in healthcare should be studied and prevented using a multifaceted approach.

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