Violence Against Emergency Department Healthcare Workers: A Nationwide Retrospective Descriptive Study of Criminal Court Judgements

AIM: To characterize the patterns and characteristics of violence against healthcare workers in emergency departments (EDs) by analysing criminal court judgements. DESIGN: Retrospective descriptive study. METHODS: We analysed 484 lawsuits adjudicated between 2018 and 2022, retrieved from the Korean Supreme Court's Written Judgement Management System database. Data on judicial, defendant, and incident characteristics were systematically extracted from written criminal judgements and summarised using descriptive statistics. RESULTS: Most defendants were patients (84%), with 71.7% having prior criminal convictions and 30.4% under recidivism or probation. Most incidents occurred at night (9 p.m.-4 a.m., 57.3%), with 42.7% of defendants under the influence of alcohol, and most frequently during diagnosis and treatment (45.0%). Physical violence was perpetrated by 288 defendants against 366 victims, most frequently targeting nurses (134) and physicians (111). Non-physical violence comprised 614 occurrences, predominantly verbal abuse, shouting, and threatening behaviour. Four victims of sexual violence and 10 occurrences of sexual harassment were documented, exclusively targeting female healthcare personnel. Non-assaultive disruptive behaviours, such as equipment destruction, were prevalent. CONCLUSION: This study identified ED violence as a multifactorial phenomenon involving alcohol intoxication, repeat offenders, and concentration during diagnosis and treatment, with nurses and physicians particularly affected due to their direct patient-care roles. Multilevel institutional strategies, combined with public awareness efforts, are needed to safeguard ED personnel. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Institutional safety frameworks are urgently needed, incorporating risk-screening for high-risk and intoxicated patients, enhanced nighttime security, blame-free reporting systems, and de-escalation training to overcome the normalization of violence and protect frontline nursing personnel. IMPACT: This study addressed ED violence by analysing 484 criminal court judgements in South Korea. Findings on perpetrator profiles, alcohol intoxication, temporal patterns, and frequent targeting of nurses provide a practical evidence base for hospital administrators and policymakers to develop targeted violence prevention strategies. REPORTING METHOD: REporting of studies Conducted using Observational Routinely-collected Data (RECORD). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.