Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence

Published:October 19, 2022DOI:



      Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings.


      This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression – Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation.


      Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation.


      Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.

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      Bonnie Hamrick is a Nurse Manager, Atrium Health, Charlotte, NC. ORCID identifier:


      Tracy Van Hassel is the Director of Informatics, South Carolina Department of Mental Health, Columbia, SC. ORCID identifier:


      Dorinda Snyder is a Service Line Nurse Educator, Atrium Health, Charlotte, NC. ORCID identifier:


      Casey Stephens is an Associate Health Services Researcher, Atrium Health, Charlotte, NC. ORCID identifier: