Hospitals Must Identify Patients at Risk to Reduce Workplace Violence
By: Richard Parker, MBA, CHFM, Associate Director
and Amy Antonacci, MSN, RN, Senior Standards Interpretation Specialist
Posted: August 22, 2025
Workplace violence in healthcare settings is a growing concern, with increasing reports of patients and visitors causing harm to staff. Too often, interventions around workplace violence are reactive and implemented only after an incident has occurred. Collaboration between clinical and facilities staff creates a structured approach to managing the risk of violence and directing the response should an incident occur.
ACHC Acute Care Hospital Standards 11.02.03 Workplace violence and 15.03.01 Identifying patients at risk, and Critical Access Hospital Standards 03.02.01 Building security, 03.02.03 Workplace violence, 03.02.05 Security incident procedures, and 06.10.08 Patient and safety: Safe Setting exemplify this partnership approach.
Prevention planning
ACHC Accreditation Standards call for hospitals to adopt proactive measures to minimize foreseeable risks of violence. This begins with the foundational requirement to screen patients for risk of harm to self or others. For example, standards 15.03.01 and 06.10.08 mandate that acute care hospitals screen for patients who may pose a threat based on their words, behaviors, or actions. This isn’t just about ticking a box on admission paperwork—it requires nuanced, multidisciplinary judgment and real-time responsiveness.
The case for comprehensive protocols
The additional standards cited outline the expectation that hospitals develop and implement robust workplace violence protocols based on an annual risk assessment. Facilities are encouraged to create protocols that meet regulatory criteria and establish a standardized approach to threat identification and mitigation. When staff are trained to recognize early warning signs—escalating agitation, threatening language, or aggressive gestures—they can take decisive steps to prevent violence before it occurs.
Collaboration across departments
Preventing workplace violence is a hospitalwide concern and responsibility. A comprehensive response includes forming multidisciplinary teams with membership representing clinical staff, security personnel, behavioral health specialists, and administrative leadership. From this collaboration, hospitals can assess risks from multiple perspectives, design effective interventions, and ensure that the entire facility is aligned in its prevention strategy.
Protocols might include:
- Universal screening tools at triage and during key patient interactions.
- Behavioral alert flags in the electronic health records.
- Escalation pathways for staff to engage security or clinical leaders.
- Environmental modifications to reduce risk in high-stress areas.
- Standard de-escalation techniques taught across departments.
These actions must be clear, repeatable, and supported by policy—especially in high-risk settings such as emergency departments or behavioral health units.
Zero tolerance is the goal
One of the strongest messages embedded in these standards is that there should be zero tolerance for harm to healthcare workers. This isn’t just an aspirational statement—it’s a directive. Hospitals have both the opportunity and the obligation to protect staff by ensuring violent behavior is never normalized or ignored. Every staff member should know how to report concerns, what responses to expect, and how their safety is being prioritized.
Focus beyond screening
Ultimately, early and accurate identification of persons at risk for harming others is the cornerstone of a safe healthcare environment. Screening alone is not enough; action must follow. Whether it’s initiating security interventions, adjusting care settings, or involving behavioral health teams, timely and appropriate responses can prevent injuries and create a safer environment for all.
As workplace violence continues to rise, the hospitals that lead in prevention will be those that see these standards not as regulatory hurdles but as frameworks for change. By embedding safety into daily operations and empowering teams to act before harm occurs, healthcare facilities can create environments where both patients and staff are truly protected.
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