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Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention

Arnetz, Judith E. PhD, MPH, PT; Hamblin, Lydia MA; Russell, Jim BSN; Upfal, Mark J. MD, MPH; Luborsky, Mark PhD; Janisse, James PhD; Essenmacher, Lynnette MPH

Journal of Occupational and Environmental Medicine: January 2017 - Volume 59 - Issue 1 - p 18–27
doi: 10.1097/JOM.0000000000000909

Objective: To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals.

Methods: Forty-one units across seven hospitals were randomized into intervention (n = 21) and control (n = 20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time.

Results: Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls (incident rate ratio [IRR] 0.48, 95% confidence interval [CI] 0.29 to 0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls (IRR 0.37, 95% CI 0.17 to 0.83).

Conclusions: This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.

Department of Family Medicine, Michigan State University, East Lansing, Michigan (Dr Arnetz); Department of Public Health and Caring Sciences, Uppsala University, Sweden (Dr Arnetz); Departments of Family Medicine and Public Health Sciences (Dr Arnetz, Ms Hamblin, Dr Janisse) and Psychology, Wayne State University (Ms Hamblin); Detroit Medical Center Occupational Health Services (Mr Russell, Dr Upfal, Ms Essenmacher); Department of Emergency Medicine (Dr Upfal); Institute of Gerontology (Dr Luborsky), Wayne State University, Detroit, Michigan; and Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet (Dr Luborsky), Sweden.

Address correspondence to: Judith E. Arnetz, PhD, MPH, PT, Department of Family Medicine, College of Human Medicine, Michigan State University, 788 Service Rd, B103 Clinical Center, East Lansing, MI 48824 (

Institute at which work was performed: Wayne State University School of Medicine.

This study was funded by The Centers for Disease Control-National Institute for Occupational Safety and Health [CDC-NIOSH], grant number R01 OH009948. The content is solely the responsibility of the authors and does not necessarily represent the official views of CDC-NIOSH. This paper is dedicated to the memory of our esteemed colleague, Joel Ager, PhD, who played a major role in the design and analysis of this project.

The authors declare no conflicts of interest.

Copyright © 2017 by the American College of Occupational and Environmental Medicine