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Background <p>Violence against emergency department (ED) healthcare workers represents a significant global challenge threatening patient care quality and staff safety. While traditional interventions show limited and inconsistent effectiveness, the deterrent potential of legislative approaches remains underexplored. This study evaluates the association between Türkiye’s comprehensive healthcare violence legislation (implemented April 15, 2020) and changes in ED violence incident rates.</p> Methods <p>We conducted a segmented negative binomial regression analysis of interrupted time series data comprising violence incidents in Turkish EDs from January 2018 to December 2024 (84 monthly observations). Data were obtained from the Ministry of Health Violence Reporting System, White Code Statistics, and Ministry of Justice databases. The pre-intervention period spanned 27 months (January 2018–March 2020) and the post-intervention period 45 months (April 2020–December 2024). Model diagnostics included Ljung–Box residual auto correlation testing and overdispersion assessment. Bonferroni correction was applied for multiple comparisons.</p> Results <p>Analysis included 47,832 violence incidents across 595 emergency departments. Following legislative intervention, an immediate level reduction of 33.2% was observed (IRR = 0.668; 95% CI: 0.623–0.716; <i>p</i> &lt; 0.001), accompanied by a significant continuing monthly decline (slope change IRR per month = 0.982; 95% CI: 0.971–0.993; <i>p</i> &lt; 0.001). Physical violence demonstrated the largest reduction (IRR = 0.625; 37.5%), followed by verbal (IRR = 0.682; 31.8%) and psychological violence (IRR = 0.820; 18.0%). After controlling for COVID-19 effects, the estimated net legislative association was a 28.7% reduction. Legal process indicators improved substantially: case filing rates increased from 12.4% to 34.7%, and conviction rates from 31.2% to 67.8%. No significant residual autocorrelation was detected (Ljung–Box Q(12) = 14.3; <i>p</i> = 0.28).</p> Conclusions <p>This study provides evidence of a statistically significant association between comprehensive healthcare violence legislation and reduced reported ED violence incident rates in Türkiye. However, the observational study design, short pre-intervention period, temporal coincidence with the COVID-19 pandemic, and potential reporting behaviour changes preclude causal inference. These findings suggest legislative frameworks may warrant investigation as one component of multi-modal ED violence prevention strategies.</p>

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Association between healthcare violence legislation and emergency department violence in Türkiye

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Mehmet Necmeddin Sutaşır,
  • Zeynep Esra Tarakçıoğlu,
  • Mohamed Mukhtar Mohamed,
  • Banu Arslan,
  • Mehmet Tatlı,
  • Müjdat Nihat Hökenek

摘要

Background

Violence against emergency department (ED) healthcare workers represents a significant global challenge threatening patient care quality and staff safety. While traditional interventions show limited and inconsistent effectiveness, the deterrent potential of legislative approaches remains underexplored. This study evaluates the association between Türkiye’s comprehensive healthcare violence legislation (implemented April 15, 2020) and changes in ED violence incident rates.

Methods

We conducted a segmented negative binomial regression analysis of interrupted time series data comprising violence incidents in Turkish EDs from January 2018 to December 2024 (84 monthly observations). Data were obtained from the Ministry of Health Violence Reporting System, White Code Statistics, and Ministry of Justice databases. The pre-intervention period spanned 27 months (January 2018–March 2020) and the post-intervention period 45 months (April 2020–December 2024). Model diagnostics included Ljung–Box residual auto correlation testing and overdispersion assessment. Bonferroni correction was applied for multiple comparisons.

Results

Analysis included 47,832 violence incidents across 595 emergency departments. Following legislative intervention, an immediate level reduction of 33.2% was observed (IRR = 0.668; 95% CI: 0.623–0.716; p < 0.001), accompanied by a significant continuing monthly decline (slope change IRR per month = 0.982; 95% CI: 0.971–0.993; p < 0.001). Physical violence demonstrated the largest reduction (IRR = 0.625; 37.5%), followed by verbal (IRR = 0.682; 31.8%) and psychological violence (IRR = 0.820; 18.0%). After controlling for COVID-19 effects, the estimated net legislative association was a 28.7% reduction. Legal process indicators improved substantially: case filing rates increased from 12.4% to 34.7%, and conviction rates from 31.2% to 67.8%. No significant residual autocorrelation was detected (Ljung–Box Q(12) = 14.3; p = 0.28).

Conclusions

This study provides evidence of a statistically significant association between comprehensive healthcare violence legislation and reduced reported ED violence incident rates in Türkiye. However, the observational study design, short pre-intervention period, temporal coincidence with the COVID-19 pandemic, and potential reporting behaviour changes preclude causal inference. These findings suggest legislative frameworks may warrant investigation as one component of multi-modal ED violence prevention strategies.