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David J. Drummond, PhD; Landy F. Sparr, MD; Geoffrey H. Gordon, MD

JAMA. 1989;261(17):2531-2534.

Abstract
We describe the success of one general hospital in reducing violent behavior among a group of repetitively disruptive patients. Following a pilot phase during which violent incidents at the medical center were characterized by location, type, and person responsible, a group of patients at high risk for repeated violence was identified (N = 48). Data were gathered for 1 year before and after the institution of a program designed to reduce violence, primarily in ambulatory care areas, among this group. Outcome assessment included comparison of the number of violent incidents and the number of visits to the medical center during the 12 months before and after the program was started. The number of incidents declined by 91.6%, and visits to the medical center for any reason decreased by 42.2%. The ratio of violent incidents to visits after the program was begun was less than one sixth the rate before the program. Components of the program are described, including staff resistance and management strategies.

(JAMA. 1989;261:2531-2534)

Author Affiliations
From the Departments of Psychology (Dr Drummond), Psychiatry (Dr Sparr), Ambulatory Care (Dr Gordon), and Medical Services (Dr Gordon), Veterans Administration Medical Center, and the Departments of Medical Psychology (Dr Drummond), Psychiatry (Drs Sparr and Gordon), and Medicine (Dr Gordon), School of Medicine, Oregon Health Sciences University, Portland.

Footnotes
Reprint requests to Veterans Administration Medical Center/Outpatient Clinic (116A-OPC), PO Box 1036, Portland, OR 97207 (Dr Drummond).

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