title: Feasibility and need for violence risk screening at triage: an exploration of clinical processes and public perceptions in one Australian emergency department.
abstract: BACKGROUND
  Research on patient aggression in hospital emergency departments supports the development of a systematic process for identifying individuals at risk of becoming violent. The feasibility and community acceptance of this approach is unknown. In this study, we determine the feasibility and explore the need for a violence risk screening process in one Australian emergency department.
  
  
  METHODS
  We used a descriptive exploratory design that involved semistructured interviews and observations of practice. The setting was an adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. A convenience sample of nine triage nurses were observed assessing patients to explore how risk screening was undertaken in practice. Semistructured interviews were conducted with emergency department (ED) service users (N=19) to explore community perspectives on the process of violence risk screening.
  
  
  RESULTS
  Observations of practice revealed that nurses used observed and reported information to screen for potential risk of violence rather than employing a direct questioning approach. Interviews with community members in the emergency department waiting room highlighted a public expectation that nurses screen and accurately identify patients at risk of violence on arrival to the ED.
  
  
  CONCLUSIONS
  Consistent with local prevalence data, public expectations of emergency care supported the need to adopt a uniform approach to identifying people at risk of becoming violent on arrival to hospital. Observations of triage nurses interactions with patients revealed that the existing violence risk screening approach was not being consistently used by triage nurses. An integrated approach to determining violence risk during triage assessment is recommended.
authors.affiliation: Consultation Liaison Psychiatry, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Daniel
authors.affiliation: School of Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Gerdtz
authors.affiliation: Centre for Psychiatric Nursing, University of Melbourne, Melbourne, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Elsom
authors.affiliation: Emergency Department, Melbourne Health, Melbourne, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knott
authors.affiliation: Centre for Psychiatric Nursing, University of Melbourne, Melbourne, Australia.
authors.forename: Roshani
authors.initials: R
authors.lastname: Prematunga
authors.affiliation: Emergency Department, Melbourne Health, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Virtue
mesh_terms: D000328:Adult; D000374:Aggression; D001291:Attitude of Health Personnel; D001315:Australia; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D009741:Nursing Staff, Hospital; D011795:Surveys and Questionnaires; D014218:Triage; D014754:Violence
keywords: risk management; triage; violence