Violence and aggression in the emergency department is under-reported and under-appreciated.

AIM: To examine levels of reporting of violence and aggression within a tertiary level emergency department in New Zealand, and to explore staff attitudes to violence and reporting.

METHOD: A one-month intensive, prospective audit of the emergency department's violence and aggression reporting was undertaken and compared with previously reported data.

RESULTS: There was a significant mismatch between the number of events identified during the campaign month and previously reported instances of violence and aggression. The findings identified that failure to report acts of violence was common.

CONCLUSIONS: Reports of violence and aggression in the emergency department underestimate the true incidence. Failure to report has potential impacts on organisational recognition of risk and the ability to develop appropriate policy responses.