Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

Sandrine Touzet, Pauline Occelli, Angelique Denis, Pierre-Loïc Cornut, Jean-Baptiste Fassier, Marie-Annick Le Pogam, Antoine Duclos, Carole Burillon, Sandrine Touzet, Pauline Occelli, Angelique Denis, Pierre-Loïc Cornut, Jean-Baptiste Fassier, Marie-Annick Le Pogam, Antoine Duclos, Carole Burillon

Abstract

Objective and setting: Primary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.

Intervention: The programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.

Participants: All patients admitted to the OED and those accompanying them.

Design: Single-centre prospective interrupted time-series study conducted over 18 months.

Primary outcome: Violent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.

Secondary outcomes: Waiting time and length of stay.

Results: There were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.

Conclusion: A comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.

Trial registration number: NCT02015884.

Keywords: health services research; healthcare workers; time-series study; violence.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study flow chart of admissions at ophthalmology emergency department (OED). Components: A, computerised triage algorithm; BC, signage and messages broadcast on TV in the waiting rooms; D, mediator; E, video surveillance.
Figure 2
Figure 2
Observed time series of the (A) rates of admission at OED with acts of violence, (B) total number of admissions at OED and (C) rates of admissions with waiting time greater than 2 hours, by month before and during implementation of the prevention programme. The grey band represents the 3-month training period. The dotted lines inside the scatter plots represents the implementation of component A (computerised triage algorithm), component BC (signage and messages broadcast on TV in the waiting rooms), component D (mediator) and component E (video surveillance). OED, ophthalmology emergency department.

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