JMIR Publications

ABSTRACT

Background:

Monitoring workplace violence (WPV) against healthcare workers (HCWs) through incident reporting is crucial to drive prevention, but actual implementation is spotty and it suffers from underreporting.

Objective:

We introduced a guidelines-driven protocol for WPV surveillance in two public hospitals in Italy, and assessed underreporting, WPV prevalence and attributes before (2016-2020) and after its implementation.

Methods:

The WPV protocol comprises of an incident report form for immediate and systematic event notification, to either risk management office or to safety personnel; a second-level root cause analysis with a dedicated psychologist; and a web-based platform for data collection and identification of high-risk workers. The protocol was designed using international standards for violence definition and attributes, and validated questionnaires for perceived stress and violence impact. It was explained to the workforce, and in particular to newly hired workers in one hospital, becoming effective since November 1st, 2021. Underreporting was estimated as observed to expected (O/E) WPV ratio less than 1. 12-month WPV prevalence in the after period was calculated for all events, for first events and recurrences.

Results:

In 2016-2020, the incident reporting systems in use in the study hospitals were not specific for aggressions. The yearly O/E WPV ratios suggested substantial violence underreporting, with diverging WPV prevalence trends over time between the two hospitals, also attributable to the different reporting protocols. Available data did not allow further WPV risk stratification. In the after period, the O/E raised to 1.91 compared to the before period, consistently in the two hospitals. Notification to risk management rather than to safety personnel was facilitated. The overall 12-month WPV prevalence was 2.08% (95%CI: 1.79%-2.42%), being 1.52% and 2.35% in the two hospitals, respectively; one-fifth was due to recurrences. Among HCWs, the youngest (3.79%, P<.001), nurses (3.19%, P<.001) and men (2.62%, P=.008) reported highest WPV prevalence. Amongst hospital wards, emergency departments and psychiatric wards were the two areas at increased risk. Physical assaults were more likely in men than in women, however the latter suffered more for mental health consequences. 41% of WPV against women recognized socio-cultural factors, and in 31% aggressors were visitors.

Conclusions:

A systematic and dedicated WPV reporting system has a positive impact on violence reporting by enforcing a confident attitude of the healthcare workers, especially the youngest, towards hospital risk management. Accurate reporting is essential to the identification of high-risk HCW to inform priorities and contents of preventive policies. Our evaluation can provide useful information for a large-scale implementation of guidelines-based WPV monitoring programs, also in other contexts.