Workplace Violence in the Emergency Department: Case Study on Staff and Law Enforcement Disagreement on Reportable Crimes

Violence in the emergency department (ED) remains underreported. Patient factors are often cited as a source of confusion in determining the culpability of perpetrators and whether to proceed with incident reporting. This study’s objective was to determine how ED staff at one academic medical center perceive certain clinical scenarios and how this compares to local law enforcement officers (LEO). An anonymous survey with 4 scenarios was sent to multidisciplinary ED staff at our academic medical center, as well as local LEO and inquired whether respondents considered any of the scenarios to be reportable as a crime. Chi-square analysis was used for comparison. The study was deemed exempt by the Institutional Review Board. A total of 261 ED staff and 77 LEO completed the survey. Both groups were equally likely to believe that a reportable crime occurred in Scenario 1, where a patient with dementia punches a nurse (LEO: 26.0% vs. ED: 31.4%, p = 0.44), and in Scenario 2, where an intoxicated patient spits at a phlebotomist (LEO: 97.4% vs. ED: 95.0%, p = 0.56). However, the two groups differed in Scenario 3, in which a patient with delirium makes verbal threats to a doctor (LEO: 20.8% vs. ED: 42.9%, p < 0.001), and Scenario 4, in which a patient’s parent throws a chair at a medical student (LEO: 66.2% vs. ED: 81.2%, p = 0.009). As health systems seek to improve workplace safety, it is important to consider the barriers to reporting violent incidents, including staff’s understanding of what acts may constitute reportable violence, as well as LEO understanding of the unique ED environment and patient responsibilities.