Predicting aggressive patient behaviour in a hospital emergency department: An empirical study of security officers using the Brøset Violence Checklist

Abstract

Introduction: The Brøset Violence Checklist (BVC) is a six item checklist that rates patients according to their risk of violence in the subsequent 24h - a score of ?3 indicates a "high risk" of violence. This study is the first to evaluate the statistical utility of the BVC when administered by a security officer in a hospital emergency department (ED).

Method: A healthcare security officer conducted BVC assessments on patients who presented to the ED of a public hospital in metropolitan South East Queensland, Australia, over a two month period. Violent/aggressive acts requiring security intervention were registered in a database.

Results: 2064 ED patients were assessed on the BVC and 35 patients committed a violent/aggressive act (1.7%). BVC sensitivity was 45.7% and specificity 99.4%. At a cut-off score of BVC3, the positive predictive value was 55.2%. Violent patients were around 71 times more likely to score BVC?3 than non-violent patients.

Conclusions: The BVC has good sensitivity, specificity, and predictive value in this setting. Using the BVC may help to implement measures that mitigate the impact of violent patients in the ED, or ideally, implement procedures that prevent violence towards ED workers in the first place.

Keywords: Brøset Violence Checklist; Emergency department; Risk assessment; Security; Violence.