Development of the Aggression and Violence Evaluation of Risk Tool (AVERT) for the Emergency Department

Development of the Aggression and Violence Evaluation of Risk Tool (AVERT) for the Emergency Department

Workplace violence is a serious problem worldwide, with recent Australian data showing a significant increase in workers’ compensation claims. The highest rates are found in the healthcare and social assistance industry, with workers frequently exposed to abuse, assault, and threats. The incidence of violence increases significantly in emergency departments (EDs). The challenge of workplace violence is the physical and psychological impact, which can include profound and long-lasting consequences. This PhD research thesis is composed of three research articles, two published and one submitted for review. The first article is a qualitative study comprising interviews of nursing and medical staff regarding their use of the Bröset Violence Checklist (BVC), a well-known and validated risk assessment tool that has been used as routine practice at the hospital ED study sites for several years. This first article summarises the workers’ opinions regarding the tool’s benefits, the advantages of embedding it into standard practice, and recommendations to improve it for this setting. The second article reports on two focus groups used to explore nursing staff who were similarly experienced with the BVC. Participants identified what they considered most important in an ED violence risk assessment instrument. Themes were explored to understand and elaborate on their selections. Together, these two articles provided an opportunity to capture a unique workforce in terms of their insights and recommendations for improving the current risk assessment scheme for context-specificity. Overwhelmingly, their feedback supported the influence of situational and environmental risks on patients’ aggressive responses. The third article is a quantitative study that tested the predictive validity of the identified risk factors alongside the BVC. Nurses collected observations over an eight-week period. These data were cross matched with security incidents and analysed to determine evidence of predictive validity. This article concludes this thesis by developing an ED-specific violence risk assessment instrument comprising four risk factors (history of violence, drug and/or alcohol influence, agitation/restlessness, and imposed restrictions) that is consistent with the themes from the previous studies which considered historical, clinical, behavioural and situational risk factors to be important considerations. As such, the Aggression and Violence Risk Evaluation Tool (AVERT) was developed to improve risk mitigation in this setting and play an integral role in enhancing patient and staff safety. Such a tool, when matched with interventions, can make a significant difference to the reactive culture often associated with EDs and prepare the workforce to anticipate risk and take practical precautions to prevent adverse injury and impact.

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