Reducing inpatient aggression: does paying attention pay off?

OBJECTIVE: Inpatient aggression is poorly documented in official records. Video technology can improve detection, but is labor-intensive and costly. We examined the effectiveness of interventions to improve reporting on a secure inpatient research unit equipped with audio/video surveillance.

METHOD: Systematic review of all video recorded during a six-week period in 2000 revealed that official documentation omitted 16/71 aggressive incidents (23%). Subsequent interventions to improve reporting involved therapy aides, whose jobs entail continuous direct contact with patients. We reviewed the corresponding period in 2005 to investigate changes in aggression and reporting.

RESULTS: Although the number of aggressive incidents did not change significantly, reporting improved: 59/62 (95%) events detected in 2005 had been reported. Physical aggression decreased and verbal aggression increased.

CONCLUSIONS: Improved reporting may have the unanticipated benefit of reducing physical aggression, perhaps by fostering recognition of and intervention in events that might otherwise escalate into more serious aggression.