Nonviolent crisis intervention training and the incidence of violent events in a large hospital emergency department: an observational quality improvement study.

Violence in hospitals complicates patient care. Emergency department settings (ED) pose significant risk for caregivers. Nonviolent crisis intervention (NCI) training was initiated to reduce the incidence of violence in an acute care hospital ED with more than 75,000 annual visitors. Training intended to build skills to defuse potentially violent situations and significantly decrease incidents in the ED requiring emergency security team involvement (manifested as code purples). A quantitative quality improvement study evaluated the training investment. The study collected ED code purple and staff training data from November 2012 to October 2013. Correlations were derived using Pearson's r. A regression model determined incremental training impact. There was a negative correlation between violence and NCI training in the previous 90-150 days; regression determined a 23% decrease in code purples, pursuant to training. Risk mitigation justified the facility's investment to continue NCI training. Training reinforcement at 6-month intervals shall be implemented for continued benefit.