Theme: Workplace Violence. 

Participants: 

Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. 

Discussion:
Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., and Mitra, B., 2017. Review article: Workplace violence in the emergency department: A systematic review and meta-analysis. Emergency medicine Australasia : EMA. 29. 10.1111/1742-6723.12761. (Nikathil et al., 2017).

Presenter:
Aran Sandrasegaran - ED SRMO at Westmead Hospital.

Summary:

• Workplace violence in the emergency department is a systematic review and meta-analysis published in 2017 in EMA by Nikathil, et al.
• From 7235 abstracts, 22 studies were deemed relevant.
• A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations.
• A secondary meta-analysis used studies reporting on the proportion of drug and alcohol-affected patients occurring within the violent population.
• It reported the prevalence of violence in Australian Emergency Departments (EDs) as at least 36 events per 10 000 patients, with about 45 in every 100 violent presentations estimated to be associated with alcohol and/or other drugs. These findings had good confidence intervals.
• The study reported that young males were the young (aged between 28-42 years) males were the primary demonstrators of violence.
• Due to statistical heterogeneity in study methodology, definitions and rates, and under-reporting the results are not a full reflection of the incidence of WPV in EDs.  

 Take-Home Points:

• Studies examining violence in the ED consistently report a high prevalence of workplace violence (WPV). Nikithil et al. is the only recent study to confirm a high proportion of violence in terms of patient presentation.
• Drugs and alcohol were commonly associated with violent episodes, often in the absence of an underlying psychiatric diagnosis.
• The findings of this study are likely an underrepresentation due to statistical heterogeneity and under-reporting and analysts and future studies must consider this.
• Public health and legal interventions are urgently required to curb workplace violence in EDs.

References: 

1. International Labour Office/International Council of Nurses/World Health Organization/Public Services International. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: International Labour Office, 2002.
2. Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., O'Reilly, G. and Mitra, B., 2017. Increasing workplace violence in an Australian adult emergency department. Emergency Medicine Australasia, 30(2), pp.181-186.

Credits:
This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. 

Music/Sound Effects

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Caroline, Kit, Pramod, Samoda, and Shreyas.

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