We assessed the environmental design elements of workplace violence (WPV) prevention in emergency department (ED) settings using a Crime Prevention Through Environmental Design (CPTED) framework. We identified opportunities for improvement in the design of future ED settings. A case-study design was used to conduct environmental walk-through assessments across 7 EDs. Security plans and committees lacked ED representation. Positive environmental design elements included good interior lighting and the use of closed-circuit television cameras. Opportunities for improvement included separating parking structures for employees from patients/visitors, locking all access points into treatment areas, frequent security patrols, and security response to all panic button activations. EDs require enhanced security and safety measures. The CPTED framework offers a promising approach to preventing WPV. Adopting positive environmental changes can mitigate the risk of WPV.
GillespieGLTamsukhinS. Why won’t it stop: workplace violence in emergency care. J Emerg Nurs2023; 49: 310–316.
5.
GillespieGLBerryP. Qualitative analysis of workplace assault outcomes from the perspectives of emergency nurses. J Emerg Nurs2023; 49: 450–460.
6.
RecskyCMoynihanMMaranghiG, et al.Evidence-based approaches to mitigate workplace violence from patients and visitors in emergency departments: a rapid review. J Emerg Nurs2023; 49: 586–610.
7.
JacobDJacobBJacobE, et al.Effectiveness of environmental design interventions to reduce aggression and violence in emergency departments: a scoping review. Health Environ Res Des J2025; 18: 26–42.
Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers (OSHA Publication No. OSHA 3148-06R 2016).Washington, DC: U.S Department of Labor, 2015.
10.
El-HadedyNEl-HusseinyM. Evidence-based design for workplace violence prevention in emergency departments utilizing CPTED and space syntax analyses. Health Environ Res Design J2022; 15: 333–352.
11.
LimMCJeffreeMSSaupinSS, et al.Workplace violence in healthcare settings: the risk factors, implications and collaborative preventive measures. Ann Med Surg2022; 78: 103727.
12.
MohammadiGorjiSBoschSJValipoorS, et al.Investigating the impact of healthcare environmental design on staff security: a systematic review. Health Environ Res Design J2021; 14: 251–272.
13.
The Joint Commission.Workplace violence prevention standards. R3 Report: Requirement, Rationale, Reference. 2021; 30: 1–6.
14.
JefferyCR. Crime prevention through environmental design. Am Behav Scientist1971; 14: 598–598.
15.
ChenGZhangSYanB, et al.Environmental safety evaluation of geopark based on CPTED concept and fuzzy comprehensive analysis. PloS One2021; 16: e0260316–e0260316.
16.
CozensPLoveT. A review and current status of crime prevention through environmental design (CPTED). J Plann Lit2015; 30: 393–412.
17.
McPhaulKMLondonMMurrettK, et al.Environmental evaluation for workplace violence in healthcare and social services. J Safety Res2008; 39: 237–250.
SharmaHKTailorRM. GIS-based crime hotspot mapping and its correlation with land use: a case study on assessment of CPTED principle. Int Soc Sci J2024; 74: 775–786.
20.
LeeSLeeCWon NamJ, et al.Street environments and crime around low-income and minority schools: adopting an environmental audit tool to assess crime prevention through environmental design (CPTED). Landscape Urban Plann2023; 232: 104676. 10.1016/j.landurbplan.2022.104676
21.
ShariatiAGueretteRT. Resident students’ perception of safety in on-campus residential facilities: does crime prevention through environmental design (CPTED) make a difference?. J Sch Violence2019; 18: 570–584.
22.
YinRK. Case study research: design and methods. 3rd ed.Thousand Oaks, CA: Sage Publications, 2003.
23.
von ElmEAltmanDGEggerM, et al.The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet2007; 370: 1453–1457.
24.
Peek-AsaCCasteelCAllareddyV, et al.Workplace violence prevention programs in hospital emergency departments. J Occup Environ Med2007; 49: 756–763.
25.
SmeijersDBenbouricheMGarofaloC. The association between emotion, social information processing, and aggressive behavior: a systematic review. Eur Psychol2020; 25: 81–91.
26.
KumariAKaurTRanjanP, et al.Workplace violence against doctors: characteristics, risk factors, and mitigation strategies. J Postgrad Med2020; 66: 149–154.
27.
GharaveisAHamiltonDKPatiD, et al.The impact of visibility on teamwork, collaborative communication, and security in emergency departments: an exploratory study. Health Environ Res Design J2018; 11: 37–49.
WaxJRCartinACraigWY, et al.U.S. acute care hospital shootings, 2012–2016: a content analysis study. WORK J Prev Assess Rehabil2019; 64: 77–83.
30.
TsengCDuaneJHadiprionoF. Performance of campus parking garages in preventing crime. J Perform Construct Facil2004; 18: 21–28.
31.
SherrillA.Workplace safety and health: additional efforts needed to help protect healthcare workers from workplace violence (GAO Publication No. GAO-16-11). Washington, DC: Government Accountability Office, 2016.
American Organization of Nurse Leaders Foundation. Leadership think tank: promoting workplace safety and preventing violence through the nursing leadership lens. Chicago, IL: AONL Foundation, 2023.
37.
Abdel-SattarSASalehMSMAleneziA. Experience of workplace violence against emergency nurses: suggesting managerial policies and control measures. Int J Adv Appl Sci2020; 7: 21–28.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
