title: Aggression in Psychiatric Wards: Effect of the Use of a Structured Risk Assessment.
abstract: Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated whether the routine use of the BVC could reduce the frequency of patient aggression. We conducted a study with a semi-random regression discontinuity design in 15 psychiatric wards. Baseline aggression risk was assessed using the Aggression Observation Short Form (AOS) over three months. The BVC was implemented in seven intervention wards, and the risk of aggressive incidents over three months of follow-up was compared with the risk in eight control wards. The analysis was conducted at the ward level because each ward was allocated to the intervention and control groups. At baseline, the risk of aggression varied between wards, from one aggressive incident per patient per 1,000 shifts to 147 aggressive incidents per patient per 1,000 shifts. The regression discontinuity analysis found a 45% reduction in the risk of aggression (Odds Ratio (OR) = 0.55, 95% confidence interval: 0.21-1.43). The study did not find a significant reduction in the risk of aggression after implementing a systematic short-term risk assessment with the BVC. Although our findings suggest that use of the BVC may reduce the risk of aggression, the results need to be confirmed in studies with more statistical power.
authors.affiliation: a Mental Health Center Sct. Hans, Clinical Mental Health and Nursing Research Unit , Roskilde , Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hvidhjelm
authors.affiliation: b Clinic of Forensic Psychiatry, Ministry of Justice , Copenhagen , Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Sestoft
authors.affiliation: c University of Copenhagen , Denmark, Department of Public Health , Copenhagen , Denmark.
authors.forename: Lene Theil
authors.initials: LT
authors.lastname: Skovgaard
authors.affiliation: d St. Olavs University Hospital, Forensic Department Brøset, Center for Research and Education in Forensic Psychiatry, Trondheim, Norway; The Norwegian University of Science and Technology, Department of Psychology , Trondheim , Norway.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rasmussen
authors.affiliation: e St. Olavs University Hospital, Forensic Department Brøset, Center for Research and Education in Forensic Psychiatry , Trondheim , Norway.
authors.forename: Roger
authors.initials: R
authors.lastname: Almvik
authors.affiliation: f University of Copenhagen, Department of Public Health, Copenhagen, Denmark; National Research Center for the Working Environment , Copenhagen, Denmark; Optum, Lincoln , Rhode Island , USA.
authors.forename: Jakob
authors.initials: J
authors.lastname: Bue Bjorner
mesh_terms: D000374:Aggression; D057189:Checklist; D006801:Humans; D011567:Psychiatric Department, Hospital; D018570:Risk Assessment; D014754:Violence