Groundbreaking ABRAT™-H Study Demonstrates Significant Reduction in Hospitalized Patient Violence, Reinforcing Efficacy of Proactive Risk Assessment Tools
A landmark interventional study—the ABRAT™-H (Aggressive Behavior Risk Assessment Tool for Hospitalized Patients)—has yielded compelling evidence that structured screening combined with targeted interventions can dramatically reduce incidents of patient violence and physical assaults in non-psychiatric inpatient hospital units. Conducted across multiple hospital units in Omaha, Nebraska, from November 2024 to August 2025, the study involved over 7,000 hospitalized patients and builds upon the success of its predecessor, the ABRAT™-ED study, which evaluated more than 77,000 emergency department (ED) patients in Grand Rapids, Michigan.
The findings from ABRAT™-H not only validate the effectiveness of the ABRAT™-H screening tool but also reinforce a scalable, evidence-based model for preventing workplace violence (WPV) across diverse healthcare settings. When high-risk patients were identified using ABRAT™-H and subsequently flagged with simple, standardized signage—either alone or in combination with proactive rounding by a Behavioral Health Response Nurse (BHRN)—hospitals observed statistically significant reductions in both the frequency and severity of violent incidents.
Study Design and Methodology: A Rigorous, Stepwise Interventional Approach
Both the ABRAT™-H and ABRAT™-ED studies employed a prospective, interventional design featuring a baseline observational period followed by two sequential intervention phases. This methodological consistency allowed researchers to isolate the impact of each intervention component and compare outcomes across different clinical environments—emergency departments versus general inpatient units.
During the baseline phase, all violent incidents were documented using the Violent Event Severity Tool (VEST™), a validated instrument designed to standardize the classification and severity scoring of violent events in healthcare settings. VEST™ captures a spectrum of behaviors—from verbal threats and property damage to physical assaults—and assigns severity levels based on injury, intervention required, and disruption to care. This granular data collection ensured reliable, comparable metrics across both studies.
In Phase 1 of the intervention, patients identified as high-risk for aggressive behavior through ABRAT™ screening received discreet but visible signage at their bedside or in their room. These signs served as non-stigmatizing alerts to clinical staff, prompting heightened awareness and preventive de-escalation strategies without compromising patient dignity.
Phase 2 introduced an additional layer of support: proactive rounding by either a Behavioral Emergency Response Team (BERT) huddle coordinator or a dedicated Behavioral Health Response Nurse (BHRN). These specialized personnel provided real-time behavioral assessments, de-escalation coaching, and rapid response capabilities for high-risk patients, further reinforcing safety protocols.
Consistent and Significant Violence Reduction Across Settings
The results from ABRAT™-H closely mirrored those of the earlier ABRAT™-ED study, underscoring the generalizability of this intervention model. In the ED study, signage alone (Phase 1) led to a 27% reduction in violent events compared to baseline, with a relative risk (RR) of 0.73 (p = 0.003)—a statistically significant and clinically meaningful improvement. Physical assaults, the most severe category of violence, also declined markedly.
Preliminary data from ABRAT™-H indicate comparable reductions in both overall violence and physical assaults among hospitalized patients. Notably, even the signage-only intervention proved effective, suggesting that early identification and environmental cueing can empower frontline staff to mitigate risk before escalation occurs. The addition of BHRN rounding in Phase 2 further enhanced outcomes, particularly in complex cases involving substance withdrawal, delirium, or undiagnosed psychiatric conditions.
Dr. Christina Vejnovich, Clinical Nurse Specialist at Nebraska Methodist Hospital and co-Principal Investigator of the ABRAT™-H study, emphasized the frontline perspective: “The nursing staff on the study units were highly supportive of the study interventions and expressed strong appreciation for the organization’s participation in proactive efforts to prevent and reduce workplace violence.” This staff buy-in is critical, as nurse engagement directly influences protocol adherence and sustainability.
Addressing a National Crisis: The Escalating Threat of Workplace Violence in Healthcare
These findings arrive at a critical juncture. Workplace violence against healthcare workers has reached epidemic proportions in the United States. According to the U.S. Bureau of Labor Statistics, hospitals report a rate of WPV-related injuries that is six times higher than the average across all private industries. Moreover, healthcare workers suffer three times more lost workdays due to violence-related injuries than their counterparts in other sectors.
The human toll is staggering: more than two nurses are assaulted every hour in U.S. healthcare settings, with patients accounting for the vast majority of perpetrators. Beyond physical harm, WPV contributes to chronic stress, anxiety, burnout, job dissatisfaction, and high turnover—factors that degrade patient care quality and strain already overburdened systems. Financially, hospitals face mounting costs from workers’ compensation claims, litigation, staffing shortages, and regulatory penalties.
Recognizing the urgency, The Joint Commission recently updated its accreditation standards to mandate comprehensive WPV prevention programs. Effective January 2024, accredited hospitals must implement organization-wide violence prevention initiatives, conduct annual program evaluations, and adopt standardized methods for collecting and reporting violent incident data. Tools like VEST™ directly support these regulatory requirements by enabling consistent, objective documentation of event types and severities.
ABRAT™: The Only Validated Dual-Setting Violence Prevention Tool
To date, the ABRAT™ suite—comprising ABRAT™-ED for emergency departments and ABRAT™-H for inpatient units—stands as the only validated risk assessment framework proven to reduce violence in two distinct clinical environments through prospective, interventional trials. Unlike generic behavioral checklists or reactive security protocols, ABRAT™ tools are specifically calibrated to predict aggression in acute care settings using evidence-based risk factors such as history of violence, intoxication, agitation, and environmental stressors.
Critically, ABRAT™ does not rely on psychiatric diagnosis or labeling. Instead, it focuses on observable, modifiable behaviors and situational triggers, making it practical for use by nurses, physicians, and support staff without specialized mental health training. The integration of simple signage and optional BHRN support creates a tiered response system that is both efficient and respectful of patient autonomy.
Implications for Policy, Practice, and Future Research
The success of ABRAT™-H and ABRAT™-ED offers a clear roadmap for hospitals nationwide seeking to comply with new Joint Commission standards while genuinely improving staff safety. Implementation requires minimal infrastructure—primarily staff training, standardized screening protocols, and signage—but yields substantial returns in reduced incidents, improved morale, and enhanced patient outcomes.
Future research should explore the tool’s applicability in other settings, such as long-term care facilities, outpatient clinics, and pediatric units. Additionally, cost-benefit analyses could quantify the financial savings associated with reduced violence, further incentivizing adoption.
As healthcare systems grapple with unprecedented staffing shortages and rising acuity levels, proactive violence prevention is no longer optional—it is essential. The ABRAT™ studies demonstrate that with the right tools, training, and organizational commitment, hospitals can transform from high-risk environments into safer, more resilient workplaces for both caregivers and patients.
For healthcare leaders committed to zero harm, the message is clear: early identification, clear communication, and targeted support work. The ABRAT™ model isn’t just effective—it’s necessary.
