Did the legal regulation implemented after acts of violence in healthcare reduce violence?

BACKGROUND: In Turkey, in May 2022, several legal regulations were introduced to prevent and reduce the increasing incidents of violence in healthcare. In this study, it was aimed to investigate whether legal regulation has an effect on reducing incidents of violence in healthcare. METHODS: This single-center retrospective observational study included data from healthcare workers who received a White Code alert in a tertiary hospital between 01.03.2021 and 01.09.2023. White Code cases were categorized into two groups: before and after the enactment of the legal regulation, known as the healthcare violence law, which was officially published in the Official Gazette. RESULTS: 132 white code cases were presented in this study. Before the enactment of the healthcare violence law, the proportion of White Code cases in the Intensive Care Unit (ICU) was 13.1%, whereas after the law, it was found to be 1.4%. Compared to the pre-legislation period, an increase in violence was observed across emergency departments, outpatient clinics, and inpatient wards [32 (52.5%) vs. 36 (50.7%), 20 (32.8%) vs. 29 (40.8%), and 1 (1.6%) vs. 5 (7%), respectively]. A statistically significant shift was noted in the distribution of White Code incident locations (p = 0.026). In the comparison of complainant and attacker genders, 75.75% of female attackers assaulted women, and the rate of women attacking other women was observed to be 2.375 times higher (p = 0.015). The mean age of the attackers who made verbal attacks was found to be higher and more significant than those who made physical attacks (37.42 ± 9.46 vs. 32.83 ± 7.52, p = 0.034 respectively). CONCLUSIONS: The decrease in incidents of violence in the ICU suggests that the legal regulation and the White Code system may have a deterrent effect in such units. In conclusion, these results show that violent incidents have shifted from intensive care units to other areas such as emergency departments, outpatient clinics, and inpatient wards. The higher rate of female perpetrators attacking female victims highlights the need to address gender-based violence risks in healthcare services.