Nurse-led hospital violence intervention programmes improve emergency department identification of violence-related visits

OBJECTIVES: Patients visiting an Emergency Department (ED) due to violence who are unable or unwilling to disclose that their injury is violence-related are unlikely to receive support for associated psychosocial vulnerabilities. Nurse-led hospital-based violence intervention programmes (HVIPs) are an additional resource in ED providing support to patients exposed to violence. Our objective was to determine whether HVIPs can overcome barriers to disclosure and what patient characteristics are associated with non-disclosure under usual care. 

STUDY DESIGN: A natural longitudinal experiment, including routine health data from 2012 to 2024, comparing intervention EDs with HVIPs to control EDs. 

METHODS: Multi-level logistic difference-in-difference models with unplanned visits clustered by patient on the probability that a visit (N = 6,724,446) was recorded as violence-related in ED or subsequently in HVIP data from Wales, UK: nine control EDs without an HVIP were compared with two intervention sites with nurse-led HVIPs. Secondary analyses assessed the characteristics of patients disclosing to the HVIP, but not under usual care by age, gender, ethnicity, and residential deprivation. 

RESULTS: The probability that a visit was designated as assault-related increased in intervention EDs following HVIP implementation (Cardiff β = 0.37, 95 % CI 0.31 to 0.44; Swansea β = 0.19, 95 % CI 0.14 to 0.25). Male, younger, those residing in deprived neighbourhoods, and black or mixed ethnicity patients were more likely to be missed under usual care. 

CONCLUSIONS: Non-disclosure is a significant barrier in provisioning support to those who are psychosocially vulnerable and likely to revisit ED. Nurse-led HVIPs can overcome inequalities in ED, reaching patient groups that are not otherwise able or willing to disclose their exposure to violence. HVIPs offer the prospect of reducing inequality in patients' visiting ED due to violence.