Workplace Violence in an Urban Community ED: Antecedents and Circumstances

Workplace Violence in an Urban Community ED: Antecedents and Circumstances

Authors: Bukhman AK, Clifford KC, Joseph JW, Schmelzer N, Chen P, Marsh R, Baymon D, Oliveira T, Waters B, Sanchez LD, Patterson T, Macias-Kostantopoulos WL, Im D

Journal: Journal of Emergency Medicine, 2025

Conclusions:

  • Psychiatric boarding and prolonged ED stays are key drivers of physical assaults against staff in a community ED setting.

  • Events disproportionately involve patients with serious mental illness, prior trauma, and social vulnerability; most assaults arise during behavioral redirection/agitation management.

  • System-level fixes—improved psychiatric bed access, structured agitation pathways, and robust de-escalation training—are likely higher-yield than ad-hoc measures.

  • Pre-event pharmacologic interventions were inconsistent; standardizing preventive sedation/antipsychotic strategies for high-risk scenarios may reduce incidents.

Results:

  • Setting/period: Urban community teaching hospital ED (Boston), Jan 2021–Apr 2023.

  • Incidents: 58 unique ED encounters with ≥1 physical assault → 121 assaults total.

  • Patient factors:

    • 50% with schizophrenia-spectrum disorder.

    • 70% on involuntary psychiatric holds.

    • 78% of assaults occurred during prolonged ED stays/psychiatric boarding.

  • Circumstances/triggers: Most assaults during behavioral redirection or agitation management.

  • Victims: Nurses 46%, security officers 42% most frequently assaulted.

  • Interventions/outcomes: Pharmacologic measures used inconsistently before assaults; a substantial proportion ultimately improved clinically.

Methods:

  • Retrospective observational study of completed physical violence against staff.

  • Case identification via hospital police/security and risk management databases; chart review for demographics, clinical factors, LOS, holds, and use of pharmacologic/physical interventions.

  • Focused analysis on antecedents (boarding, holds, substance use) and context of violent episodes.

Bukhman, A.K., Clifford, K.C., Joseph, J.W., Schmelzer, N., Paul, C., Marsh, R., Baymon, D.M., Oliveira, T., Waters, B., Sanchez, L.D. and Patterson, T., 2025. Workplace Violence in an Urban Community Emergency Department: A Deeper Dive into the Antecedents and Circumstances of Violent Behaviors. The Journal of Emergency Medicine.

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