Practice Improvement| Volume 49, ISSUE 3, P352-359.e1, May 2023

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Violence Risk Assessment in the Emergency Department



      Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency.


      Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared.


      Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints.


      The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.

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      Janis M. Quinn, Member, Illinois State Chapter, is an Advanced Practice Registered Nurse, Emergency Department, Ann & Robert H. Lurie Children’s Hospital of Chicago; and an Assistant Professor, Rosalind Franklin University of Medicine and Science, Chicago, IL. ORCID identifier:


      Joy M. Koopman, Attending Physician, Emergency Medicine, Health System Clinician in Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL.