When the Waiting Room Becomes a Warzone: Predictive Modeling of Workplace Violence in Emergency Departments Using Patient Acuity and Staffing Ratios

Abstract

The workplace violence rates of the emergency department of a hospital are crisis rates, and emergency nurses are four times more likely to be attacked than the average worker in the private sector. Most health systems rely on incident reporting rather than prevention. The article describes a predictive model whereby a dynamic Violence Risk Score (VRS) is generated based on real-time patient acuity, staffing ratio, patient history flags and operational variables for each patient encounter. Using the framework of the ARM and the Total Cost of Risk approach, the article shows how the real cost of ED workplace violence in the forms of staff turnover, temporary labour, litigation, and reputation is significantly greater than what the workers' compensation Diablo entry reports. A viable six-step implementation roadmap is provided to risk managers and patient safety officers.