Tools to predict imminent risk of patient perpetrated workplace violence in healthcare settings: an umbrella review

Workplace violence (WPV) in healthcare settings affects the safety and well-being of healthcare professionals and impacts the quality of care delivered to patients. Type 2 WPV involves violence directed towards staff by patients or visitors and includes physical and verbal violence. The prevalence of Type 2 WPV in healthcare settings has prompted the need for effective predictive assessment tools to identify the risk of imminent violence to enhance the safety of both healthcare workers and patients. There are many tools represented in the literature and identification of the best tool for a patient care setting can be challenging. The purpose of this umbrella review was to evaluate the characteristics, validity, and reliability of healthcare violence risk assessment tools presented in review literature to support organizational decision-making. Publications up to June 2024 were analyzed. Article inclusion criteria included articles from peer reviewed journals, published in English, specific to healthcare, and addressed tools which were predictive of imminent violence (defined as predictive to occur within one week). From 292 identified studies, 14 review articles met the inclusion criteria, representing more than 111,000 participants. Across these reviews, 19 tools were identified and 12 tools had published data on validity and reliability. The Brøset Violence Checklist (BVC) and the Dynamic Appraisal of Situational Aggression (DASA) were the most consistently evaluated, with the strongest psychometric data. The BVC AUC (area under the curve) ranged from 0.69 to 0.98, sensitivity ranged from 45.7% to 88.6%, specificity ranged from 80% to 100%, PPV (positive predictive value) ranged from 3% to 67.5%, and NPV (negative predictive value) from 97% to 99.5%. The DASA’s AUC ranged from 0.59 to 0.92, sensitivity ranged from 23% to 87%, specificity ranged from 42% to 96%, PPV ranged from 4 to 15%, and NPV from 98% to 99%. Other strong tools included ABRAT and QOVPRAO. The BVC and DASA are the most represented tools, include the most consistent validity and reliability metrics, and have diverse utility within various clinical settings. The ABRAT has also been utilized in a variety of settings yet has a larger number of assessment items (16) compared to the BVC and DASA at six and seven respectively.