Prevalence, determinants, and consequences of workplace violence in emergency departments - a systematic review

Background Workplace violence, including physical assault, verbal abuse, and bullying, is a growing public health concern worldwide. EDs are consistently identified as high-risk environments due to overcrowding, high emotional stress, time pressure, and frequent interactions with distressed patients and relatives. In Pakistan, evidence on the prevalence and determinants of WPV in ED settings remains fragmented. This systematic review aimed to synthesize available evidence on the prevalence, forms, perpetrators, and contributing factors of workplace violence against healthcare professionals in emergency departments, with particular attention to findings from Pakistan within the broader international literature. Methods A systematic review was conducted in accordance with PRISMA guidelines. Four electronic databases (PubMed, ScienceDirect, Web of Science, and CINAHL) were searched for English-language peer-reviewed studies published between January 2015 and December 2025. Quantitative, qualitative, mixed-methods, and relevant evidence-synthesis studies examining workplace violence among healthcare professionals in emergency care settings were eligible for inclusion. Methodological quality and risk of bias were assessed and considered during interpretation of the findings. Results Twenty-nine studies met the inclusion criteria. Across studies, the prevalence of workplace violence ranged from approximately 33% among healthcare workers in Pakistan to over 90% among emergency nurses in Taiwan. Verbal abuse was the most frequently reported form of violence, affecting 52–91% of healthcare professionals, while physical violence ranged from 7.8% to 74.9%. Patients and their relatives were consistently identified as the primary perpetrators. Major determinants included communication failures, prolonged waiting times, overcrowding, staff shortages, night-shift duties, and limited professional experience. Workplace violence was frequently underreported because of normalization of violence, lack of organizational support, and ineffective reporting systems. Reported consequences included psychological distress, anxiety, reduced job satisfaction, increased turnover intentions, and impaired perceptions of workplace safety. Conclusion Workplace violence against healthcare professionals in emergency departments is a common and multifactorial problem driven by interpersonal, organizational, and contextual factors. Addressing workplace violence requires comprehensive strategies that strengthen communication practices, improve reporting mechanisms, enhance workplace security, support healthcare workers, and address organizational contributors such as overcrowding and staffing shortages. Future research should prioritize multicenter studies, standardized measurement approaches, and evaluations of interventions designed to prevent workplace violence in emergency care settings. Clinical trial number Not applicable.