The Aggression and Violence Evaluation of Risk Tool: A Context‐Specific Instrument to Assess Risk of Violence in the Emergency Department

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Abstract
Aim: To evaluate the relationship between the Bröset Violence Checklist and additional risk factors identified in prior research by our team to determine which combination best predicted an emergency response to a violent incident in an emergency department. Design: A prospective observational study was used to collect data about a single cohort of adult patients admitted in August 2024. Method: Nurses who use the Bröset Violence Checklist as part of routine observations scored eight additional violence indicators and recorded security incidents. Results: Data from 5634 observations, 1762 patients, and 68 emergency incidents was analysed using a combination of descriptive and inferential statistics to evaluate the relationship between factors and incidents. Seven factors correlated significantly with violence ( p < 0.05). Three factors (verbal threats, physical threats, and attacking objects) were excluded as they represent manifestations of violence rather than predictive indicators. Receiver Operating Characteristics analysis of the combination of the remaining four factors (history of violence, drug and/or alcohol influence, agitation/restlessness, and imposed restrictions) revealed an Area Under the Curve of 0.98. Conclusion: The findings were integrated to develop a revised instrument—the Aggression and Violence Evaluation of Risk Tool. This new tool demonstrates equivalent predictive capability to the Bröset Violence Checklist, yet it is simpler and easier to use. Impact: Context‐specific violence assessment schemes are needed to strengthen risk mitigation strategies. The Aggression and Violence Evaluation of Risk Tool incorporates unique situational risks developed specifically for emergency departments. It has the potential to effectively ameliorate violence risk and enhance worker and patient safety. Reporting Method: STROBE has been followed. Implications: The findings produced an instrument that can be translated to emergency departments to reduce the prevalence of violence. Patient or Public Contribution: Limited patient and public involvement comprising observations of adult patients in an emergency department in Melbourne, Australia.
Funding Information
  • Western Health Foundation

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