Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients in Non-Psychiatric Inpatient Units

Abstract

Aim: To refine and validate an electronic version of the Aggressive Behaviour Risk Assessment Tool (ABRAT) and determine the sensitivity and specificity for identifying potentially violent patients in non-psychiatric inpatient units.

Design: A prospective cohort study design was used.

Methods: All patients admitted or transferred to three inpatient units of an acute care hospital in Nebraska, USA, from 7 February to 9 April 2023, were included. The 10-item ABRAT assessments were performed daily for the first 3 days of admission. The violent events were collected until discharge in three categories: Physical aggression towards others, physical aggression towards property and verbal intimidation/threat towards others. Kendall's tau tests and a multivariate logistic regression procedure were performed to select a parsimonious set of items that best predict violent events.

Results: Of 1179 patients, 69 had ≥1 violent event (5.9%). The revised six-item tool with item weighting was named ABRAT for Hospitalised Patients (ABRAT-H). The area under the curve from the Receiver Operating Characteristics analysis was 0.82. The sensitivity and specificity at a cutoff score of two were 68.1% and 85.2%, respectively. As ABRAT-H scores increased, the percentage of violent patients also increased and for patients with scores ≥5, 55.2% became violent.

Conclusion: ABRAT-H appears to be useful for identifying potentially violent patients in non-psychiatric inpatient units with satisfactory sensitivity and specificity.

Implications for patient care: The availability of ABRAT-H may help provide focused preventive measures that target patients at high risk for violence and reduce violent events.

Impact: A majority of the nursing workforce is employed in acute care hospital setting, and the availability of ABRAT-H can further enhance the culture of a safe work environment and have positive impacts not only on the nurses' physical and mental health but also on the quality of patient care.

Reporting method: We have adhered to relevant STROBE guidelines for reporting observational studies.

Patient or public contribution: No Patient or Public Contribution.

Keywords: inpatient units; non‐psychiatric; screening tool; sensitivity; specificity; workplace violence.