Table 3.

Summary of reviews and systematic reviews

Reference	Setting	Level/ grade	Study design	Intervention	Outcome	Results (grade)
Calow et al 58	ED Nursing ED Psyinpatient setting	Level 3 Low	Review: Evaluation of the use of risk assessment tools in the ED 13 articles included No studies with RCT design	Use of risk assessment tools in ED. Does the use of an aggression risk assessment tool reduce the future risk of violence towards the healthcare worker? STAMP: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing. BVC: BrØset Violence Checklist inpatient setting, psychiatric units: 6-item tool confusion, irritability, boisterousness, physical threat, verbal threat, attack on objects.	Prediction of short-term violence. Reduction of violence.	Lack of high-quality studies. Most prevalent risk assessment tools with good validity and sensitivity for early identification of aggressive behaviour: STAMP and BVC. STAMP violence assessment framework has been shown to be an effective tool in early identification of violent behaviour in the ED setting (moderate). BVC is the most prevalent tool in the inpatient setting and shows best validity and reliability. (moderate). There was no reporting on reduction of violence.
Kynoch et al 59	Acute hospital setting Nursing ICU ED	Level 3 Low	Systematic review Interventions for preventing and managing aggressive patients in acute hospital setting. 1990–2007 10 articles included No studies with RCT design.	Staff training. Pharmacological treatment. Mechanical restraint.	Patient aggression. Staff injuries, staff confidence, knowledge, attitude, stress. Early detection of aggressive behaviour.	Lack of high-quality studies. Training results in increased knowledge, skills and confidence to manage aggressive situations (low). Medication helps to reduce the incidence of aggressive behaviour in patients in the acute setting (moderate). In acute care setting mechanical restraints have minimal complications when used for short periods of time (low).
Lipscomb and Ghaziri60	Front-line healthcare worker nursing USA	Level 3 Low	Literature Review: Workplace violence prevention: improving front-line healthcare worker safety	Flagging patient with history of violence against staff Training: for example, web-based NIOSH training Workplace violence prevention programme	Reduction in assault by the patient	Lack of high-quality studies. 90% reduction in assaults by flagging high-risk patients in veteran healthcare (moderate). Training is necessary but there is little evidence on impact. Complex and mixed findings on effect of workplace violence prevention programmes.
Runyan et al 29	Medical Healthcare	Level 3 Low	Systematic review Studies included were mainly pretest and post-test study design No studies with RCT design	Behavioural interventions Administrative interventions	41 papers: Sensible Recommended Interventions but no hard data· Nine articles reported results of intervention evaluations	Haddon matrix. Overall, the research designs employed were weak and the results inconclusive. None used experimental designs. Results: decline in frequency of assaults after implementation of a peer help programme for assaulted staff (low). Unavailability of debriefing counselling was associated with increased reports of post-traumatic stress (moderate). Training programme: conflicting evidence. Psychiatric setting: training in aggression control technique: likelihood of assault 3% vs 37% in non-trained, but potential bias associated with decision to be trained (low). No significant differences in assault-related injuries between the trained and untrained groups (low). Psychiatric setting: no significant difference in number of injuries reported from pretest and post-test 4-day training (low). Flagging patients with repeated history of violent events. 90% reduction in assault by high-risk patients in veterans administration hospital (moderate). Quality management approach: improvements in inpatient violence: for example, 40% reduction in mealtime incidents after changes in lunchroom procedures (low).
Price et al 25	Mental health setting Mainly nurses Psy	Level 2 Moderate	Systematic review: 38 relevant studies Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. 23 uncontrolled cohort studies. 12 controlled cohort studies· three case control studies· No studies with RCT design	training on violence including de-escalation technique	Cognitive outcome Affective outcome Behaviour change Reduced escalations Reduced assault rates Reduced usage of containment	Quality of studies: moderate to weak. Cognitive outcome: enhanced de-escalation knowledge gain, ES: 0.91, 1.13, 1.39 (moderate). Affective outcome: increased confidence to manage aggression, ES:<0.2, 0.76, 1.04 (moderate). No evidence on subjective anxiety regulation. Skills: improved de-escalation performance: ES >0.8 (moderate). Assault rates: mixed outcomes: 3 studies with reduced risk of assault, 2 studies with no significant effect. Incidence of aggression: mixed outcomes with increases in aggression possibly due to increased reporting. Significant reduction in incident rates measured at ward level: ES 0.64. Injuries: mixed outcomes. Positive effects in reducing injuries at ward level, not at individual staff level: ES 1.13. Containment: reduced use of physical restraint (low). Non-significant reduction in use of rapid tranquilisation (low), no effect on supply of extra medication (low). Organisational: reduction in lost workdays: ES 1.47 (moderate).
Wassell61	GEN Retail industry	Level 3 Low	Systematic review Workplace violence intervention effectiveness	Interventions in the healthcare and retail industry		Although the article provides a good overview of the published literature, a more in-depth reporting of the relevant underlying studies is provided in the current systematic review.
Morphet et al 62	GEN		Scoping review Prevention and management of occupational violence and aggression in healthcare	Environmental risk management Consumer risk assessment Staff education	20 selected articles	More in-depth reporting of the relevant underlying studies is provided in the current systematic review.

ED, emergency department; RCT, randomised controlled trial.