Guiding clinical judgment and management: An evaluation of a screening tool for short-term inpatient violence

Historically, the focus on inpatient units has not been the prevention or management of violence risk, but reacting to the violence after an incident. Violence on these units leads to physical, emotional, and economic consequences for perpetrators, victims, and the mental health system. Although short-term risk assessments have been developed to specifically address the risk for inpatient violence, these measures have only been implemented on the inpatient units and not in the Emergency Department (ED), which is often the first point of contact for the mentally ill. The purpose of the present study was to determine if a framework that uses structured professional judgment (SPJ) principles in the Emergency Department (ED) could predict violence within an inpatient unit. The Inpatient Violence Screening Tool (IPVST) SPJ framework was comprised of several pre-existing measures and four additional items culled from a literature review. These measures include the Brøset Violence Checklist (BVC; Almvik & Woods, 1998) and the Dynamic Appraisal of Situational Aggression (DASA-IV; Ogloff & Daffern, 2006a). A third short-term risk assessment, the McNiel Violence Checklist Revised (VSC and VSC-R; McNiel & Binder 1994), was coded based on files. Participants were 697 individuals who presented to the psychiatric ED at a general hospital and were interviewed by the Psychiatric Triage Nurses (PTNs). The follow-up sample was 207 patients who were subsequently admitted to an inpatient unit. The IPVST was completed by the PTNs after their interview; the VSC, VSC-R and outcome data were collected from files of the follow-up sample. The results of this study partially supported the use of the IPVST as a risk assessment framework in the ED to prevent inpatient violence. There was consistency in SPJ ratings amongst the majority of the PTNs. The IPVST total score and SPJ rating were significantly related to management strategies as well as significantly related to inpatient violence. The AUCs of the total scores of the IPVST and the individual measures were between .62-.65, except for the BVC, which was not a significant predictor of inpatient violence. The AUCs for the categorical risk rating of the BVC, DASA, VSC, and VSC-R were between .54-.64. Implications for risk assessment and management are discussed.