Weapons possession by patients in a university emergency department

Study objective: Violence in the emergency department, a not uncommon but complex phenomenon, may become more serious when patients possess weapons. Searches are used frequently to reduce this danger, though guidelines for searches are not well delineated. We examined our practices in order to formalize our guidelines. Design: Retrospective chart review of patients found to be carrying weapons. Setting: General, university-based emergency department in the Northwest. Participants: Of 39,000 patients seen during the 20-month study period, 500 (1.3%) were searched. Measures and main results: Of all patients seen in the ED, 92% were medical patients (153, 0.4% of whom were searched) and 8% were psychiatric patients (347, 11.1% of whom were searched). Weapons were found on 89 patients (0.2% of all ED patients and 17.8% of all patients searched). Review showed that 24 (15.7%) medical and 60 (17.3%) psychiatric patients carried weapons. Conclusion: Although various factors contributed to a clear bias toward searching psychiatric patients, we believe that the rate of weapons possession did not support this bias.