The development of an aggression risk screening process for ED triage: Implementation and preliminary outcomes

Background: Research indicates aggression prevention requires a systematic process for identifying high risk individuals on arrival to the ED. This paper will discuss how aggression risk screening was developed and present preliminary findings. Method: Audit: A 12 month retrospective audit of security responses (N=1959) to manage aggression were analyzed. The sensitivity and specificity for the implementation phase identified if triage nurses can identify patient who will require an emergency response during ED treatment. Observations: Purposive samples of 10 triage nurses were observed to record how risk screening could be used. Public perceptions: Semi structured interviews with a convenience sample of ED service users (N=19) used thematic analysis to summaries participants’ perspectives on aggression screening. Results: A high risk group of patients presented more than once in 12 months was identified. Although this group represents only 12% (105/857) of patients, they accounted for 577/1796 (32%) of emergencies. Observing triage practice revealed that nurses’ use observed and reported information rather than direct questioning. Interviews revealed a strong expectation that nurses identify and manage risk of aggression at triage in order to protect the public. Over half the patients who required a security response were identified at triage. Conclusion: This study developed an aggression risk screen that is integrated with current ED triage nurse practice. This process allows for prevention to commence once patients at risk of aggression/violence are identified. Cathy Daniel et al., J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002