Simon C. Moore, Sinéad Brophy, Amrita Bandyopadhyay, Megan Hamilton, Henry Yeoman, A Battaglia, David O'Reilly, Lara Snowdon, Jonathan Shepherd, Danny Tod, Alan Watkins, Vas Sivarajasingam, Simon Walker, Shainur Premji
Background: Emergency Department (ED) care of people injured in violence is increasingly seen as an opportunity to address patients' psychosocial vulnerabilities as well as their treatment. These vulnerabilities include alcohol, drug use, mental health and social vulnerabilities that are also associated with high levels of unplanned ED attendances for reasons other than violent injury. Since evidence of the effectiveness of interventions designed to reduce these risks is weak, we evaluated the impact of nurse-led Hospital Violence Intervention Programmes (HVIPs) across two sites in Wales, United Kingdom, on subsequent unplanned ED attendance. Methods: We used anonymised country-wide electronic health and administrative data to identify a cohort of patients, from 2019 to 2024, injured in violence who attended EDs in Wales, United Kingdom. We matched the characteristics of patients who engaged with the HVIP to control patients in the same cohort. We estimated the unadjusted hazard ratio (HR) for subsequent unplanned ED attendances for patients, and adjusted HRs to determine HVIP effectiveness overall and for sub-groups based on age and gender. This study is registered with ISRCTN (68945844). Findings: For patients who engaged with the intervention (n = 2068; representing 3580 attendances), the frequency of subsequent ED attendances was lower than control patients (n = 6196; 12,174 attendances; HR = 0.95, 95% CI 0.91-0.99). The intervention was more effective for female patients (HR = 0.86, 95% CI 0.80-0.92) and those aged 11-17 (HR = 0.88, 95% CI 0.82-0.92) and 18 to 30 (HR = 0.86, 95% CI 0.80-0.92) years of age. Interpretation: If risk factors associated with violence related injury are identified and addressed as part of ED care, ED attendances can be reduced. Funding: This study is funded by the National Institute for Health and Care Research, Public Health Research Programme (NIHR134055).