Incident of violence escalation of patients with psychiatric emergencies boarding in the emergency department in the Central Region of Thailand and its association: A prospective observational study

Background: This study aimed to investigate the incidence of violence escalation in psychiatric emergency patients who were admitted to general emergency departments. The study also determined patient and service delivery system factors associated with the survival time of violence escalation in 16 emergency departments in the central region of Thailand. The research design was a prospective observational study, and the study sample includes 507 psychiatric emergency patients over the age of eighteen, selected through stratified random sampling and purposive sampling. Methods The study analyzes patient data consisting of demographic data, emergency services used, and clinical characteristics using descriptive statistics. The Kaplan-Meier method was used to estimate the violent escalation curve, and the log-rank test was used to compare violent escalation-free time between the levels of the violent behavior group. Additionally, univariable and multivariable Cox proportional hazard analyses were used to investigate the factors affecting violence escalation. Results The results of the study indicate that the incidence of violent escalation of patients with psychiatric emergency boarding in the emergency department was 7.3%, while the incidence rate of violence escalation was 3 per 100 psychiatric emergency patient visits-hours. The factors affecting violent escalation were the violence behavior score at triage (aHR = 2.004; 95% CI: 1.051–3.823) and the nurse competency score (aHR = 0.147; 95% CI: 0.032–0.680). Conclusions Assessing the violent behavior of psychiatric emergency patients at triage may assist emergency providers in monitoring patient behavior and providing early intervention to prevent the escalation of violent behavior. Furthermore, training emergency nurses in psychiatric emergency care is required.