ARTICLE IN PRESS
Psychosomatics 2018:&:1 7 © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.
Original Research Article
Impact and Prevalence of Physical and Verbal Violence
Toward Healthcare Workers
TagedPLisa J. Rosenthal, M.D., FACLP, Ashley Byerly, M.B.A., M.P.H., Adrienne D. Taylor, M.D.,
Zoran Martinovich, Ph.D.
Background: Threatening and assaultive behaviors
against healthcare workers is a growing national con-
cern.1,2,3 To assess the incidence and impact of aggres-
sion against healthcare workers, a safety and quality
improvement project was initiated in an academic, ter-
tiary care, and urban hospital. Methods: Through the
Northwestern Academy of Quality and Safety Initiatives
program, an invitation to complete an online survey was
sent to healthcare workers. The survey inquired about
prevalence, location, and type of experience of physical
or verbal abuse by patients or families. Other goals were:
1) worker knowledge and use of reporting systems
2) effect on healthcare worker engagement, and 3) report
of posttraumatic symptoms. Results: 34.4% of healthcare
workers reported any incident of verbal or physical vio-
lence in the proceeding 12 months, with 13.5% reporting
TagedPKey words: healthcare worker wellness, workplace violence, posttraumatic stress, physician engagement, security,
nursing.
TAGEDH1INTRODUCTIONTAGEDN
TagedPThreatening and assaultive behaviors against healthcare
workers are a growing national concern that impacts
retention and engagement of the workforce, and affects
patient safety and healthcare quality.1,2,3 The incidence
of these events also appears to be increasing,4 and
according to a 2013 Occupational Safety and Health
Association report, injury resulting from violence that
Received February 6, 2018; revised April 27, 2018; accepted April 27,
2018. From the Department of Psychiatry and Behavioral Sciences
(L.J.R., A.D.T., Z.M.), Northwestern University, Chicago, IL;
Human Resources (A.B.), Northwestern University, Feinberg School
of Medicine, 446 E Ontario St, 7th Floor, Chicago, IL 60611
Psychosomatics &:&, & 2018
physical assault. Of those with any incident of physical or
verbal violence, 60.2% endorsed at least one posttrau-
matic symptom, 9.4% missed work, and 30.1% had
thoughts about leaving their job or career. The reported
impact was the same for physical or verbal incidents.
Discussion: Physical and verbal abuse of healthcare
workers is prevalent and has a significant impact on
employee engagement and posttraumatic spectrum symp-
toms. These results are based on a cross-sectional survey
at one institution and may have a significant selection and
response bias. Conclusion: Assessment of both verbal and
physical aggression against healthcare workers should be
standard. Front line consulting psychiatrists and psychi-
atric programs for employee wellness could assess and
manage this impact.
(Psychosomatics 2018; &:1 7)
TagedPrequired time away from work in healthcare was qua-
druple that of private industry.5,6,7 Based on criteria for
Occupational Safety and Health Association reportable
events, those reports do not contain incidents of verbal
assault or attempted physical assault without injury,
thus data about the impact and prevalence of less
violent events is very limited.
TagedPIn 2002, the National Institute for Occupational
Safety and Health defined workplace violence as, “the
Send correspondence and reprint requests to Lisa J. Rosenthal, M.D.,
FACLP, Northwestern University, Feinberg School of Medicine, 446 E
Ontario St, 7th Floor, Chicago, IL 60611; e-mail: lrosenth@nm.org
© 2018 Academy of Consultation-Liaison Psychiatry. Published by
Elsevier Inc. All rights reserved.
www.psychosomaticsjournal.org 1
 ARTICLE IN PRESS
Violence Toward Healthcare Workers
TagedPact or threat of violence, ranging from verbal abuse to
physical assaults directed toward persons at work or on
duty.”8 As defined, violence includes events that do not
result in physical injury. However, these events are not
included in mandated reporting, thus there is an ongo-
ing need to demonstrate the incidence and impact on
involved workers. Previous healthcare worker surveys
have demonstrated a significant number of verbal
assaults on healthcare workers and have included some
impact data, but few were completed in the US with
wide survey of hospital environments, worker types,
or inclusion of posttraumatic spectrum symptoms.9
Although the Joint Commission mandates action taken
to assess and address violence, it is not clear that hospi-
tals are collecting data of incidents without physical
injury routinely; without this data it seems unlikely that
they are creating programs that truly meet the needs of
the workforce.
TagedPConsulting psychiatrists in the hospital are often
involved in clinical care and policy creation for agitated
patients, and are frequent witnesses to violent incidents
and their aftermath. There is limited evidence base to
guide assessment of physicians and other healthcare
workers following these events, or to guide support for
wellbeing of affected staff and faculty. With further
data, psychiatrists can be advocates to assess and
address the impact of aggressions against healthcare
workers. Consulting psychiatrists are also uniquely
posed to impact perceptions of “psychiatric patients,”
including improving screening for common etiologies of
aggression such as neurocognitive disorders.
TagedPIn our tertiary care, urban, academic medical center
there was strong interest in addressing violence, but it
was immediately apparent that we first needed accurate
measurement of physical and verbal assault directed
against our workforce. Standard methods of reporting
existed but demonstrated low incidence and did not
assess for prevalence, location, or type of healthcare
worker involved, or resulting impact of incidents with-
out physical injury in a standardized fashion.
TagedPHealthcare workers may be reluctant to report vio-
lence, as described in Phillips’ review on the epidemic of
violence in healthcare.1 Root cause analysis suggested
that this was the case at our institution. Other potential
barriers included multiple disconnected and laborious
reporting systems, limited knowledge of reportable
event criteria, healthcare worker reluctance to “com-
plain,” lack of education on posttraumatic symptoms,
2 www.psychosomaticsjournal.org
TagedPunfamiliarity with best reporting practices or available
support services, and disinterest or cynicism about
reporting sequela such as counseling.
TAGEDH1MATERIALS AND METHODSTAGEDN
TagedPThrough the Northwestern Academy of Quality and
Safety Initiatives (AQSI) program, a multidisciplinary
team was assembled by the primary author (LR),
including members from medicine, psychiatry, emer-
gency medicine, social work, nursing leadership, human
resources, and security, as well as resident trainees from
psychiatry and internal medicine. The AQSI selected
this proposed project for a year-long certificate program
that includes classes and leadership coaches. The
quality initiatives focused on Northwestern Memorial
Hospital, an 894-bed, tertiary care, urban, academic
medical center. The hospital had approximately 86,300
emergency room presentations and 69,400 observation
and inpatient admissions in 2016.
TagedPThe team reviewed existing reports of violence
against healthcare workers at the hospital and found
three administratively separate systems. These included
a Risk Management driven online reporting system
for safety or systems concerns involving patients, the
Human Resources Employee Incident Report online
system focused on Occupational Safety and Health
Association (OSHA) reportable events, and the security
department’s informal record of violent events on the
hospital campus that included statements about injured
employees. Details included in these reports did not per-
mit cross referencing. In 2016, a total of 117 reports
were made in these three systems, 56 of which were
through the appropriate channel of Human Resources.
These results suggest far less than 2% reported any inci-
dent, and only 19 reports referenced verbal assault.
Data was so limited that the AQSI team was unable to
initiate interventions to address violence without fur-
ther information.
TagedPInvestigation began to assess the prevalence, tar-
gets, locations, and impact of physical and verbal vio-
lence within the hospital. With the support from AQSI
and Hospital Administration, an IRB exempt online
survey was sent to all medical staff physicians, nurses,
nurse assistants, advance practice providers, and
social workers. Reported populations on distribution
e-mail lists were 2005 physicians, 445 nurse practi-
tioners or physician assistants, 2455 nurses, and 52
Psychosomatics &:&, & 2018
 ARTICLE IN PRESS
Rosenthal et al.

TagedPSocial Workers. Approximately 275 certified nurse
assistants received invitations; numbers are not exact
due to manager distribution methods. Other types of
healthcare workers such as respiratory therapists, physi-
cal and occupational therapists, radiology technicians,
and medical trainees were excluded.
TagedPThe survey required at least 12 months employ-
ment at the hospital and asked a series of 18 ques-
tions about physical or verbal assault and its impact.
The goal was to determine prevalence, location, and
type of healthcare worker experience of physical or
verbal abuse by patients or families. Other goals
were: 1) worker knowledge and use of reporting sys-
tems, 2) effect on healthcare worker engagement, and
3) report of posttraumatic symptoms. The project
was deemed IRB exempt. Data was reviewed with a
statistician.
sTagedP o, the relevant statistics for the contrasted full analytic
sample are listed.
TAGEDH1RESULTSTAGEDN
TagedPOf 948 respondents to the survey, 802 were eligible to
provide complete responses (Table 1). The vast majority
of ineligible responses were due to duration of employ-
ment under twelve months. There was an approxi-
mately 19% response rate to the survey, without the
exact number of direct daily care providers (mostly cer-
tified nursing assistants). Of the 802 eligible respond-
ents, 34.4% reported any incident of physical or verbal
abuse in the proceeding twelve months, of which 13.5%
were identified to be physical assault (Table 2).
TagedPResults found that the emergency department had
the highest incidence and prevalence of violence, with

Statistics TABLE 1. Sociodemographic Characteristics of Respondents

(N = 802)
T he mean number of incidents of abuse, violence, or
agedPT Variables N (%)
threats for various multicategory predictors (duration Total sample 802
of employment, hospital department, professional role, Sex
sex of respondent, and race) was estimated. A Poisson Male 169 (21.2)
Female 630 (78.8)
regression model was used to estimate confidence inter- Race
vals for each category level, with associated Wald z tests White 585 (72.9)
contrasting each category vs the full sample average Black 65 (8.1)
Latino 36 (4.5)
number of incidents. In addition, the percent of cases
Asian/Other Pacific 88 (11.5)
reporting any incidents, with confidence intervals and z Clinical role
tests also contrasting the indicated category vs the Clinical nurse 435 (54.2)
full sample was estimated. These inferential tests were Physician 160 (20.0)
APP (APN/PA) 71 (8.9)
z tests for contrasting independently sampled propor- Direct daily care 57 (7.1)
tions (i.e., square root of chi-square test of indepen- Social worker 23 (2.9)
dence for the 2 £ 2 case). The tests and statistics were Duration of employment
Employed 1 to < 3 years 192 (23.9)
repeated for three additional “count” variables: Phys- Employed 3 to < 8 years 201 (25.1)
ical violence incidents, Verbal threat incidents, and Employed 8 to < 16 years 213 (26.6)
the number of posttraumatic stress disorder symp- Employed 16+ years 196 (24.4)
Hospital department
toms endorsed (and percent with 1 or more, or 2 or
Emergency 49 (6.1)
more posttraumatic stress disorder symptoms) given Medicine 190 (23.7)
any incidents of abuse. Critical care areas 88 (11.0)
TagedPRegarding sample sizes and inferential contrasts Psychiatry 40 (5.0)
Neurology 36 (4.5)
comparing cases identified in each row category vs all Orthopedics 16 (2.0)
other cases, the number of subjects in low-n, or other, Postsurgical 61 (7.6)
or “missing” categories are not listed; thus, the sub- Cardiology 35 (4.4)
Operating room 53 (6.6)
sample rows are not exhaustive in some cases. How- Procedural areas 50 (6.2)
ever, the inferential tests do contrast the cases Oncology 55 (6.9)
identified in the row category vs all other cases, which Research unit 5 (0.6)
Women’s health 109 (13.6)
is equivalent to a contrast vs the full analytic sample;

Psychosomatics &:&, & 2018 www.psychosomaticsjournal.org 3

 ARTICLE IN PRESS
Violence Toward Healthcare Workers

TagedP83.7% reporting any incident, and a mean of 28.22
events per respondent. Medicine wards, psychiatry, and
critical care areas had the next highest percentages of
affected employees, with the highest mean number of
events. The lowest percentage of affected employees,
and lowest number of events per worker were within
women’s health areas.
TagedPResults by healthcare worker role were significantly
different, with 39.1% of nurses reporting a mean of 4.15
TagedPevents, 50.9% of direct daily care providers reporting a
mean of 3.6 events, and 21.9% of physicians reporting
any incident of violence with a mean of 2.73 events.
TagedPIncidence was not statistically different between
male and female respondents but mean number of
events was, with 31.4% of men reporting a mean of 7.5
incidents per worker, and 35.2% of women with mean
2.25 events, and a p value of < .001. Thus, males
reported far more events per person than women.

TABLE 2. Physical and Verbal Assaults by Sex, Race, Clinical Role, Duration of Employment, and Department
Variable Total Any assault Physical assault Verbal assault
N % No. of CI % No. of CI % No. of CI
incidents incidents incidents
(mean) (mean) (mean)
Total sample 802 34.4 3.35 3.23 3.48 13.5 0.36 0.32 0.40 31.9 2.70 2.58 2.81
Sex
Male 169 31.4 7.50*** 7.10 7.92 9.4 0.46 0.36 0.57 22.2 6.31*** 5.95 6.70
Female 630 35.2 2.25*** 2.14 2.37 10.5 0.33 0.29 0.39 32.7 1.73*** 1.63 1.84
Race
White 585 33.8 3.68*** 3.53 3.84 14.4 0.41*** 0.36 0.46 31.5 2.94*** 2.80 3.08
Black 65 40.0 1.40*** 1.14 1.72 10.8 0.22 0.13 0.36 36.9 1.02*** 0.80 1.29
Latino 36 41.7 5.00*** 4.32 5.79 13.9 0.19 0.09 0.41 38.9 4.22*** 3.60 4.95
Asian 88 29.5 2.10*** 1.82 2.43 11.4 0.24 0.16 0.37 28.4 1.74*** 1.48 2.04
Clinical role
Physician 160 21.9 2.73*** 2.49 3.00 8.1 0.26* 0.19 0.36 21.3 2.43* 2.20 2.69
Clinical nurse 435 39.1 4.15*** 3.96 4.35 18.2 0.49*** 0.43 0.56 35.4 3.19*** 3.03 3.37
APP (APN/PA) 71 11.3 0.38*** 0.26 0.55 4.2 0.04*** 0.01 0.13 11.3 0.27*** 0.17 0.42
Direct daily care 57 50.9 3.60 3.14 4.12 19.3 0.46 0.31 0.67 47.4 2.96 2.55 3.45
Social worker 23 52.2 2.13* 1.61 2.82 4.3 0.04* 0.01 0.31 52.2 1.83* 1.35 2.47
Duration of employment
Employed 1 to 192 37.0 6.16*** 5.82 6.52 20.8 0.58*** 0.48 0.70 34.9 5.18*** 2.20 2.69
< 3 years
Employed 3 to 201 37.8 3.04* 2.81 3.29 14.9 0.43* 0.35 0.53 35.3 2.45* 3.03 3.37
< 8 years
Employed 8 to 213 34.7 2.59*** 2.38 2.82 11.3 0.23*** 0.17 0.30 30.5 1.72*** 0.17 0.42
< 16 years
Employed 16+ years 196 28.1 1.76*** 1.58 1.95 7.1 0.20*** 0.15 0.27 27.0 1.57*** 1.41 1.76
Hospital department
Emergency 49 83.7 28.22*** 26.78 29.75 38.8 1.92*** 1.57 2.35 81.6 25.04*** 23.68 26.48
Medicine 190 41.6 3.11* 2.86 3.37 18.9 0.44* 0.36 0.55 39.5 1.99*** 1.80 2.20
Critical care 88 43.2 2.16*** 1.87 2.49 23.9 0.52* 0.39 0.70 37.5 1.61*** 1.37 1.90
Psychiatry 40 47.5 1.83*** 1.45 2.30 7.5 0.08* 0.02 0.23 47.5 1.55*** 1.21 1.99
Neurology 36 33.3 1.47*** 1.12 1.93 11.1 0.36 0.21 0.62 33.3 1.08*** 0.79 1.48
Orthopedics 16 25.0 1.44*** 0.96 2.16 18.8 0.44 0.21 0.62 18.8 0.75*** 0.43 1.32
Postsurgical 61 29.5 1.41*** 1.14 1.74 9.8 0.15* 0.08 0.28 29.5 0.95*** 0.74 1.23
Cardiology 35 22.9 1.03*** 0.74 1.43 8.6 0.31 0.17 .057 22.9 0.80*** 0.55 1.16
Operating room 53 17.0 0.91*** 0.68 1.20 0 13.2 0.81*** 0.60 1.09
Procedural areas 50 26.0 0.66*** 0.47 0.93 4.0 0.04* 0.01 0.16 24.0 0.36*** 0.23 0.57
Oncology 55 27.3 0.58*** 0.41 0.82 12.7 0.18* 0.10 0.34 20.0 0.35*** 0.22 0.54
Research unit 5 20.0 0.20* 0.03 1.42 0 20.0 0.20* 0.03 1.42
Women’s health 109 9.2 0.17 0.11 0.27 1.8 0.03*** 0.01 0.09 7.3 0.15*** 0.09 0.24

* p value < 0.05.

*** p value < 0.001.

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 ARTICLE IN PRESS
Rosenthal et al.

TABLE 3. Impact of Any Assault: Physical, Verbal, or Both

Reported impact
1 or more posttraumatic symptoms
2 or more posttraumatic symptoms
Missed days from work
Thoughts about leaving job or career
TagedPWomen comprised 78.8% of the respondents who indi-
cated gender. Data about the gender of the total sample
who received invitations to complete the survey is not
known.
TagedPAlso significant were reports by duration of
employment. For employees who reported working
between 12 and 36 months, there was a mean number
of events of 6.16 (confidence intervals 5.82 6.52), vs
those employed > 16 years, reporting a mean number
of events of 1.76 (confidence intervals 1.58 1.95,
p < .01).
TagedPOne of the primary goals of the survey was to deter-
mine whether employees felt they knew how to report
violence that affected them. Overall, 75.8% of respond-
ents indicated belief in their knowledge of reporting
methods, but only 53.4% who reported having a violent
incident indicated this same knowledge. When asked
what channels they used to report events, 42.8%
endorsed telling their supervisor, 21.7% used reporting
TagedPsystems for risk management, 17% told security, and
%
only 7.6% reported using the employee incident report-
ing system run by Human Resources, which is the
60.2
19.5 appropriate pathway for reporting in the health system.
9.4 Those who asserted knowledge of reporting practices
30.1 appear to have been challenged once they experienced a
reportable event, and most believed that telling their
supervisor completed their report.
TagedPOf those experiencing at least one verbal or physical
incident the reported impact was quite significant
(Table 3). 9.4% of respondents with an incident of vio-
lence reported missing work, and 30.1% thought of
leaving their job or career. 60.2% endorsed at least one
posttraumatic symptom, and 19.2% reported at least
two posttraumatic symptoms. There was no statistical
difference on impact between physical vs verbal events
for any of these measures, including posttraumatic
symptoms, missed work, or thoughts of leaving work.
TagedPAvailable data from the survey did not allow for
cross calculation of posttraumatic symptoms by hospi-
tal location. Cross calculation was completed for
worker type, and found that there was limited statistical
difference in posttraumatic symptoms according to
worker clinical role or duration of employment
(Table 4).
TagedPWithin incidents of verbal harassment, respondents
indicated that 10% (N = 261) were felt to be based on

TABLE 4. Posttraumatic Symptoms Based on Duration of Employment and Professional Role

Variable 1 or more posttraumatic symptoms 2 or more posttraumatic symptoms
% z p value % z p value
Duration of employment
Employed 1 to < 3 years 59.2 ¡0.27 0.79 16.9 ¡0.57 0.57
Employed 3 to < 8 years 59.2 ¡0.27 0.79 22.4 0.82 0.41
Employed 8 to < 16 years 59.5 ¡0.22 0.83 17.6 ¡0.42 0.68
Employed 16+ years 65.5 0.84 0.40 20.0 0.17 0.87
Clinical role
Physician 42.9 ¡2.24 0.03 22.9 0.53 0.60
Clinical nurse 61.7 0.66 0.51 17.9 ¡0.85 0.40
APP (APN/PA) 62.5 0.14 0.89 25.0 0.39 0.70
Direct daily care 75.0 1.70 0.09 28.6 1.27 0.20
Social worker 58.3 ¡0.13 0.90 25.0 0.49 0.63

Survey questions asked about posttraumatic symptoms:

Have you experienced any of the following as a result of one or more of the incidents (choose as many as apply):
A Nightmares, or unavoidable intrusive thoughts or memories of the incident.
B On guard, watchful, easily startled.
C Felt numb or detached, from others, activities or your surroundings.
D Avoided situations that reminded you of the incident.

Psychosomatics &:&, & 2018 www.psychosomaticsjournal.org 5

 ARTICLE IN PRESS
Violence Toward Healthcare Workers
TagedPrace, 16% (N = 404) on gender, and 13% (N = 333) on
sexual identity.
TAGEDH1DISCUSSIONTAGEDN
TagedPA large number and variety of healthcare workers indi-
cated feeling threatened or abused by patients and fami-
lies in a tertiary care, urban, academic medical center.
The highest impact appears to be on nurses and direct
care providers, and overall numbers were far higher
than formal system existing reports suggested. Hospi-
tal areas most affected included the emergency
department, medicine floors, psychiatry unit, and crit-
ical care areas.
TagedPThe results of this survey may have a significant
response bias, as those employees affected by violence
may have been more likely to respond to a survey invi-
tation on that topic. Thus, actual rates and impact
might be lower than suggested. In addition, the survey
was at a single, urban, academic institution, and results
may have been influenced by factors at this site not pres-
ent at others. However, the numbers reported are simi-
lar to, and in some cases lower than, prior reports,
including incidence and impact.9,10
TagedPHigher rates of reported violence in newer employ-
ees may suggest that they are more vulnerable to vio-
lence, or may be more likely to interpret events as
violent or assaultive. Alternatively, long-term health-
care workers may become desensitized, or be less likely
to interpret events as violent.
TagedPReported impact on work engagement was found
to be highly significant, suggesting that many affected
healthcare workers miss work and consider leaving
their jobs, or even their careers, because of both ver-
bal and physical violence. The reported impact was
the same whether the worker endorsed verbal or phys-
ical assault. The large reported impact of verbal
harassment is particularly striking because verbal
assault reports are not mandated or otherwise encour-
aged. Verbal assault, along with all lessor injuries that
do not require medical treatment beyond first aid, are
not considered Occupational Safety and Health Asso-
ciation reportable events or included in most pub-
lished numbers despite some prior evidence that the
prevalence is high.11
TagedPAlthough this survey was not designed to diagnose
acute stress disorder or posttraumatic stress disorder,
posttraumatic symptoms appear prevalent among
6 www.psychosomaticsjournal.org
TagedPworkers endorsing verbal and physical violence. This
study did not assess whether these symptoms were further
associated with missed work or career and job dissatisfac-
tion, which could be investigated. A published prospective
study of violence did not report percentages of affected
respondents but did find significant impact of posttrau-
matic symptoms on work engagement.12 There did not
appear to be significant difference in impact between types
of healthcare workers, despite differences in incidence.
TagedPThis survey demonstrated barriers to reporting at
our institution, including healthcare worker knowledge
of reportable events and appropriate reporting chan-
nels. Tested knowledge of reporting was far below per-
ceived knowledge. There was clear opportunity for
improvement in recording and addressing these inci-
dents, as has been recommended after other investiga-
tions.13 Healthcare organizations could do a better job
of actively tracking events, which in turn must be
prompted by mandated reporting.
TagedPOur community is responding, including the crea-
tion of a single pathway for reporting violence against
employees, with creation of specific reports to assess
physical assault, attempted assault, and verbal violence.
Existing reporting systems described above have new
methods of coordination to appropriately funnel all
types of violence against healthcare workers to the
Human Resources system. For example, if a patient
safety event report includes a description of violence
against a healthcare worker, Human Resources is now
alerted to the report. Education about the reporting
process has been expanded, through intranet educa-
tional campaigns, mandated employee education about
violence and reporting, and dissemination of informa-
tion by security and nursing leadership. The human
resources department contacts every employee who sub-
mits a report, and the health system is investigating
options to expand the response to employees who may
be less interested in counseling (for example, offering
classes in self-defense).
TagedPComments received in this survey included many
variations of complaints about “psych patients,” though
the majority of healthcare worker injuries from violence
are due to neurocognitive disorders and intoxication.1
Education with colleagues and staff is critical to the liai-
son function of consulting psychiatrists, to address
assumptions or biases about psychiatric disorders and
the etiologies of violence, and to ensure that clinical
pathways are adequate. Consulting psychiatrists are
Psychosomatics &:&, & 2018
 ARTICLE IN PRESS
TagedPalso uniquely posed to address burnout and wellness in
our co-workers.
TAGEDH1CONCLUSIONTAGEDN
TagedPPhysical and verbal abuse of healthcare workers is preva-
lent and has a significant impact on employee engagement
and posttraumatic spectrum symptoms. These results are
based on a cross-sectional survey at one institution and
may have a significant response bias. There is opportunity
for improvement in reporting and addressing these inci-
dents, and assessment of both verbal and physical aggres-
sion against healthcare workers should be standard.
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TagedPThe authors report no proprietary or commercial
interest in any product mentioned or concept discussed
in this article.
Acknowledgments: W TagedP e are thankful to our col-
leagues and team members on AQSI project “Calling Dr.
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