Violent events and security programs in California Emergency Departments before and after the 1993 Hospital Security Act.

INTRODUCTION: Health care workers have long been recognized as having a high risk of work-related assault. In response to a growing threat of violence in hospitals, California implemented the Hospital Security Act (AB508) in 1993. This study compares surveys of emergency nurses before and after implementation of AB508. METHODS: In 1990, the CAL/ENA surveyed emergency departments in California to enumerate violent events and describe security programs. Using the CAL/ENA membership directory, hospitals were resurveyed in 2000 to identify changes from the original survey. Surveys were mailed to the ED nurse manager or equivalent. Survey responses were anonymous. RESULTS: Most hospitals reported fewer violent episodes after the implementation of AB508. However, 32% of hospitals reported that 5 or more verbal threats occurred monthly, and 5% reported that 5 or more violent injuries occurred monthly. Overall, hospitals reported improvements in security programs. The most notable increase was in employee training, which rose from 34% to 95.6% of reporting hospitals. However, almost a quarter of hospitals reported not having general violence prevention policies, and many believed that security personnel were inadequate. DISCUSSION: Although results reported here cannot be directly attributed to AB508, the increase in security program components suggests that hospitals are responding positively to reduce violence. The high prevalence of threats and violent events reported indicates a persistent risk of violence against health care workers.