Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
News

New tool evaluates risk of patient aggression

Lauren Vogel
CMAJ July 12, 2016 188 (10) E200; DOI: https://doi.org/10.1503/cmaj.109-5276
Lauren Vogel
CMAJ
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

A free electronic tool that tracks changes in a patient’s likelihood of becoming violent could revolutionize how health care workers manage aggression.

The electronic Hamilton Anatomy of Risk Management tool, or e-HARM, walks users through a four-step evaluation of past and present factors to determine a patient’s future risk for violence. The tool’s developers at St. Joseph’s Healthcare Hamilton in Ontario have done this kind of guided risk assessment on paper for almost a decade. Unlike paper-based predecessors, however, the e-HARM aggregates and charts the data it captures over time. This allows clinicians to instantly graph an individual’s or a group’s history of aggression against changes in other factors, like medication adherence.

The tool represents an “absolute breakthrough in forensic mental health,” and a version for use in general psychiatry is on its way, says Dr. Gary Chaimowitz, who heads St. Joseph’s forensic psychiatry program. “Clinically, we’re now in a better position to understand patients, their risks and the roads to recovery.”

Frontline workers in the forensic psychiatry program at St. Joseph’s now document all aggressive incidents using a 9-point scale. This captures everything from rudeness (level one) to life or death incidents involving the police and medical attention for the victim (level nine). The reports also note whether and how health workers intervened following an incident. An example of a patient’s monthly chart might show a spattering of ones or twos, with a three or four leading up to a level seven incident.

Figure

St. Joseph’s Healthcare Hamilton in Ontario has developed a new tool for assessing and managing patient aggression.

Image courtesy of KatarzynaBialasiewicz/iStock

The e-HARM tool connects these incident reports to the bigger picture of a patient’s history, including past and present diagnoses, behaviour and treatments. Clinicians weigh all these factors using the assessment portion of the tool to capture a patient’s evolving risk on a monthly or more frequent basis.

Using the tool’s analytic functions, health workers will hopefully be able to spot escalating behaviour before it boils over and measure whether interventions to reduce violence actually work, Chaimowitz says. There is also “amazing research potential” because the e-HARM tool can aggregate and analyze data from multiple patients, units or institutions.

“With a click of a button, I can tell you how many people with a specific diagnosis I have on the unit, what programs they’re using and what seems to be effective,” he explains. “In terms of quality improvement, we’re going to be light-years ahead.”

The forensic version of the tool is already attracting interest from health workers across Canada. In addition to training sessions in Hamilton and North Bay, Ontario, St. Joseph’s has run workshops in Vancouver and Winnipeg.

Still, not everyone is eager to apply a big data approach to mental health care. According to Chaimowitz, “some people feel that it may take away some of their independence around decision-making.”

Others at a recent Risk and Recovery Forensic Conference in Hamilton questioned whether the information provided by the e-HARM tool might bias health workers against riskier patients.

Chaimowitz says that hasn’t been the experience at St. Joseph’s, where the tool has been used for several months. “The more knowledge staff had about the person’s risk issues, the more comfortable they felt,” he says. “It’s better to have that information rather than fearing unknowns.”

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (10)
CMAJ
Vol. 188, Issue 10
12 Jul 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
New tool evaluates risk of patient aggression
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
New tool evaluates risk of patient aggression
Lauren Vogel
CMAJ Jul 2016, 188 (10) E200; DOI: 10.1503/cmaj.109-5276

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
New tool evaluates risk of patient aggression
Lauren Vogel
CMAJ Jul 2016, 188 (10) E200; DOI: 10.1503/cmaj.109-5276
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Saying goodbye to CMAJ News
  • National survey highlights worsening primary care access
  • How Canadian hospitals are decreasing carbon emissions
Show more News

Similar Articles

Collections

  • Topics
    • Medical careers
    • Patient education
    • Patient safety & quality improvement

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire