Violence follows the patient. So should your prevention strategy.
Connect the dots before violence travels. Early alerts and smarter handoffs protect staff, reduce liability, and lead to safer care for everyone.
This special edition of Left of Boom is for healthcare leaders addressing the growing challenge of workplace violence. A recent study confirms what those of us working in healthcare violence prevention have long known from experience. Aggression does not stay confined to one department. It moves with the patient, from the ambulance to the emergency department to inpatient units.
The study offers no major surprises, but it provides solid academic validation and hard data to support what frontline practitioners already see every day. It gives you a clearer picture of the problem and a better foundation for taking meaningful action to protect staff and improve care.
What the study tells us
The researchers followed thousands of patient encounters and found:
- 28% of patients who were violent in one setting continued to be violent in another.
- 7% were violent across four different settings (ambulance → ED → hospital floor → somewhere else).
- Violence wasn’t random. Many patients had known histories of aggression in one part of the care system before showing up in another.
- Not all violence is the same. Younger patients tended to cause acute aggression in EMS
- and ED (often tied to intoxication or psychiatric crisis). Older patients were more likely to become violent later in the hospital stay due to delirium or dementia.
Violence against healthcare workers doesn’t just happen in one place, it moves with the patient. In simple terms, if a patient lashes out in the ambulance, there’s a strong chance they’ll also lash out in the ED, and possibly again on the hospital floor. Violence is not random. it’s a predictable pattern along the care continuum. And if it’s predictable, it’s preventable.
What does this mean for healthcare security leaders?
The biggest vulnerabilities:
- Communication gaps are dangerous. If EMS, ED, and inpatient teams don’t share risk information, Staff are repeatedly walking into preventable danger because they don’t know the patient’s history.
- Critical safety information gets lost at handoffs between EMS, ED, and inpatient units.
- Underreporting is hiding the true scale. Out-of-hospital teams (such as EMS) documented more because it was mandatory; inside hospitals, reporting is cumbersome, so many incidents aren’t logged. If reporting isn’t simple and required, the data you’re using for staffing and planning is incomplete.
If you’re only looking at violence in the ED or only tracking behavioral health incidents, you’re missing the bigger picture.
Violence has memory.
Past behavior is one of the strongest predictors of future incidents.
Turning insight into action
Where to focus your efforts
Stopping violence from moving through your system starts with closing the gaps that allow it to escalate.
- Connect the dots across care settings – Create a longitudinal alert system. If a patient is violent with EMS, ED staff should know before arrival. If they’re violent in the ED, that flag should follow them to the floor. Behavioral safety plans or EMR chart flags must travel with the patient.
- Hardwire violence risk alerts into every handoff. Just like you always communicate allergies or code status, violence risk should be part of every transition.
- Simplify reporting. If it’s hard to report, staff won’t do it. Better data means betterresponse and better prevention planning. Quick-click EMR tools make it easier for staff todocument incidents and produce better data.
- Tailor training to the risks in each setting.
- ED: focus on intoxication, acute psychiatric crisis, and de-escalation during immediate medical emergencies.
- Inpatient units: focus on delirium, dementia, and medically fragile patients whobecome combative.
- Train all staff on handling visitor or family aggression
Close the loop with EMS and external partners. Share violence history back to EMS so they’re prepared for repeat encounters. Communicate with outpatient clinics, many of these patients cycle back into the system.
Quick Wins You Can Implement Today
Flag risk early – address violence risk on every patient handoff
Make it visible – pilot EMR alerts that follow the patient across all units
Stay ahead of escalation – hold daily huddles for flagged patients
Capture the real data – simplify incident reporting with one-click tools
Train where it matters most – give units setting-specific de-escalation skills
What you should takeaway
This changes how you should think about prevention. This research reframes the issue from viewing it as isolated flare-ups to a continuum of risk. We must stop thinking “the ED is dangerous” and start thinking “this patient is dangerous across the system.”
If it’s predictable, it’s preventable. What makes the difference is how well you connect information, prepare staff, and intervene before escalation.
This study makes the path forward clear: improve how risk information travels, make violence alerts visible across all settings, tailor staff training to the real threats they face, and capture better data through simple reporting.
Healthcare leaders must recognize that violence prevention isn’t just a “security problem”, it’s a patient safety and workforce retention problem that touches the whole organization.
Violence has real costs:
- Staff injuries and burnout lead to turnover and staffing shortages
- Escalating incidents increase liability and reputational risk
- Chaotic environments disrupt care and erode patient trust
The bottom line
Violence follows the patient. Your interventions must follow faster.
This study validates what frontline staff already know. Now it’s on leadership to connect the dots, close the gaps, and build a safer system, for your people, your patients, and the future of your organization.
Reference:
McGuire, Sarayna S. et al. Continuing Violence From the Out-of-Hospital Setting to the Emergency Department and Hospital: A Cohort Study on Longitudinal Violence in Health Care. Annals of Emergency Medicine.
