Violent behavior by emergency department patients with an involuntary hold status

Nancy L. Dawson, Christian Lachner, Tyler F. Vadeboncoeur, Michael J. Maniaci, Veronica Bosworth, Teresa A. Rummans, Archana Roy, M. Caroline Burton

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Violence against health care workers has been increasing. Health care workers in emergency departments (EDs) are highly vulnerable because they provide care for patients who may have mental illness, behavioral problems, or substance use disorders (alone or in combination) and who are often evaluated during an involuntary hold. Our objective was to identify factors that may be associated with violent behavior in ED patients during involuntary holds. Methods: Retrospective review of patients evaluated during an involuntary hold at a suburban acute care hospital ED from January 2014 through November 2015. Results: Of 251 patients, 22 (9%) had violent incidents in the ED. Violent patients were more likely to have a urine drug screen positive for tricyclic antidepressants (18.2% vs 4.8%, P = 0.03) and to present with substance misuse (68.2% vs 39.7%, P = 0.01), specifically with marijuana (22.7% vs 9.6%, P = 0.06) and alcohol (54.5% vs 24.9%, P = 0.003). ED readmission rates were higher for violent patients (18.2% vs 3.9%, P = 0.02). No significant difference was found between violent patients and nonviolent patients for sex, race, marital status, insurance status, medical or psychiatric condition, reason for involuntary hold, or length of stay. Conclusion: Violent behavior by patients evaluated during an involuntary hold in a suburban acute care hospital ED was associated with tricyclic antidepressant use, substance misuse, and higher ED readmission rates.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Hospital Emergency Service
Tricyclic Antidepressive Agents
Hospital Departments
Delivery of Health Care
Insurance Coverage
Marital Status
Cannabis
Violence
Substance-Related Disorders
Psychiatry
Length of Stay
Patient Care
Alcohols
Urine
Pharmaceutical Preparations

Keywords

  • Involuntary hold
  • Violence
  • Workplace violence

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Violent behavior by emergency department patients with an involuntary hold status. / Dawson, Nancy L.; Lachner, Christian; Vadeboncoeur, Tyler F.; Maniaci, Michael J.; Bosworth, Veronica; Rummans, Teresa A.; Roy, Archana; Burton, M. Caroline.

In: American Journal of Emergency Medicine, 2017.

Research output: Contribution to journalArticle

Dawson, Nancy L. ; Lachner, Christian ; Vadeboncoeur, Tyler F. ; Maniaci, Michael J. ; Bosworth, Veronica ; Rummans, Teresa A. ; Roy, Archana ; Burton, M. Caroline. / Violent behavior by emergency department patients with an involuntary hold status. In: American Journal of Emergency Medicine. 2017.
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abstract = "Background: Violence against health care workers has been increasing. Health care workers in emergency departments (EDs) are highly vulnerable because they provide care for patients who may have mental illness, behavioral problems, or substance use disorders (alone or in combination) and who are often evaluated during an involuntary hold. Our objective was to identify factors that may be associated with violent behavior in ED patients during involuntary holds. Methods: Retrospective review of patients evaluated during an involuntary hold at a suburban acute care hospital ED from January 2014 through November 2015. Results: Of 251 patients, 22 (9{\%}) had violent incidents in the ED. Violent patients were more likely to have a urine drug screen positive for tricyclic antidepressants (18.2{\%} vs 4.8{\%}, P = 0.03) and to present with substance misuse (68.2{\%} vs 39.7{\%}, P = 0.01), specifically with marijuana (22.7{\%} vs 9.6{\%}, P = 0.06) and alcohol (54.5{\%} vs 24.9{\%}, P = 0.003). ED readmission rates were higher for violent patients (18.2{\%} vs 3.9{\%}, P = 0.02). No significant difference was found between violent patients and nonviolent patients for sex, race, marital status, insurance status, medical or psychiatric condition, reason for involuntary hold, or length of stay. Conclusion: Violent behavior by patients evaluated during an involuntary hold in a suburban acute care hospital ED was associated with tricyclic antidepressant use, substance misuse, and higher ED readmission rates.",
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