• Overview of the ISTV programme and how it works.
• Awareness of the Serious Violence Duty.
• Understanding of ISTV’s importance to ED and UTC practice.
• Understanding of ED/UTC nurse’s role in ISTV.
• Knowledge of the core ISTV data items and how to record them.
• Links to further resources.

Violence has a devastating impact on the lives of victims, families and communities and is a major public health concern globally. EDs and UTCs are often the first or only point of contact for people injured in assaults. This means staff can play a vital role in prevention through the ISTV programme.

With the introduction of the Serious Violence Duty in 2022, there is now a statutory requirement for health services and other authorities to work together to prevent and reduce serious violence.

The Duty specifically highlights the role of ISTV. By understanding ISTV, nurses and other ED/UTC staff can contribute to efforts to reduce violence and create safer communities.

ISTV is part of a public health approach to reducing violence. A small, anonymised dataset (which does not identify individuals) is collected in EDs and UTCs about the ‘when’, ‘how’ and ‘where’ of violent incidents.

This data is shared with relevant authorities (Community Safety Partnerships/CSPs, and Integrated Care Boards in England, or Local Health Boards in Wales), to support violence reduction strategies and routine operational work.

• Staff in EDs/UTCs record specific information when patients present with violence-related injuries.
• This information is then anonymised and shared with the authorities responsible for violence reduction.
• Authorities analyse the data to identify risks, patterns and hot spots.
• The intelligence is used to inform violence reduction strategies, commissioning decisions and routine operational violence prevention work.

ISTV data does not play any role in safeguarding individuals, identifying perpetrators or criminal justice proceedings. Safeguarding and statutory reporting procedures must still be followed as per local policies.

Studies have consistently shown that only 23-33% of violent incidents requiring treatment in EDs/UTCs appear on police records, for reasons such as institutional mistrust, fear of repercussions and fear of having their own conduct scrutinised.

This means that EDs and UTCs have access to unique information about the hidden level and nature of violence, the places where violence is prevalent and risk factors for victims.

By recording and sharing anonymised data, ED/UTC staff can contribute to a system-wide understanding of otherwise hidden violence, better equipping partners to develop and implement violence reduction strategies and prevention measures.

The sharing of anonymised data to support violence reduction interventions is based on the Cardiff Model, which, following its implementation in 1997, resulted in a significant reduction of violence-related hospital admissions and in police records of serious violence.

Nurses play a vital role in ISTV. They are often the first, and sometimes only, point of contact for patients, and are therefore critical in identifying individuals affected by violence.

The information required for ISTV reporting is collected through routine enquiry from a mixture of staff groups throughout the patient’s episode of care. This includes reception staff, triage nurses and treating clinicians. Nursing staff need to understand who collects what information within their local ED team.

Most information needed for ISTV would be routinely gathered as part of standard history-taking or triage assessment. Patients usually volunteer the information readily, particularly when approached with professional curiosity and sensitive questioning – private settings also help patients feel comfortable. There will, however, be occasions when patients cannot tell you because they are seriously injured or unsure of what happened.

Each department should have a lead for ISTV (often a senior nurse, consultant or manager). Their responsibilities should include linking in the local informatics teams to ensure:

• their EPR system allows ISTV data to be recorded easily
• informatics teams share regular reports of ISTV data
• relevant staff groups receive ISTV training
• they check and track data quality
• lead efforts to improve data quality (will require multidisciplinary input)
• build relationships with key partners, for example, Community Safety Partnerships (CSPs), and share feedback with staff.

Further information

NHS England. Collecting violent injury data – Emergency Care Dataset (ECDS)v4 & Information Sharing to Tackle Violence (ISTV) Supporting guidance (PDF).

WHEN

Arrival date and time: This is the date and time the patient arrives at the department, which is automatically recorded when they register.

Injury date and time: This is the approximate date and time the injury occurred. If the exact date and time are unknown, they should be estimated .

HOW

Injury intent

This is how an assault presentation is flagged. There are two assault options: 

• apparent assault (single assailant) 
• apparent assault (multiple assailants).

If you do not know how many people were involved, best judgement should be used.    

Other options (non-assaults) include: 

• self-inflicted injury 
• Non-intentional injury/accidental injury 
• injury caused by an animal 
• injury due to legal intervention 
• complication of medical care.

Injury mechanism

This is how the main injury was inflicted.  If the exact cause is not listed, choose the closest one. Examples of injury mechanisms are: 

• punch with a fist 
• kick with the foot 
• human bite 
• stabbed/cut with a knife 
• asphyxia by obstruction of the mouth and nose. 

Recording injury mechanisms is very important because it can show changing or emerging patterns of violence. For example, the Institute For Addressing Strangulation highlights the need to collect strangulation data (which would be coded as Asphyxiation: other) so that services can understand how common it is and create resources to respond and prevent it.  

WHERE

(Geographical) Assault location description 

This is the geographic location where the assault happened (not where the injury is on the body) and is a free text field. It is the most important field for CSPs, helping to identify violence hot spots and supporting contextual safeguarding work. 

The location should be as specific as possible, ideally specific enough to pinpoint on a map, but must not identify the patient, perpetrator or any private address.  

Top tips for recording high-quality location data

Ask the patient, “Where were you when this happened?” If you get a vague answer, such as “Camden”, ask a further question such as “Whereabouts in Camden?” Naming a venue or landmark makes the data useful locally. For example:

• Camden (large geographical area, low resolution).
• Camden Town (smaller geographic area, still low resolution).
• Camden Town Tube Station (good resolution, locatable).

Be mindful of duplicate venue and street names. For example:   

• Red Lion Pub (too many potential matches).
• Red Lion Pub, Station Road, Anytown (good resolution, locatable).

Avoid abbreviations as these may not be recognised. For example:

• ‘Whipps Cross Hospital’ (good resolution, locatable).
• NOT ‘WXH’ (not recognisable).

What you document in this field is exactly what gets shared. Remember, this data is anonymised – the recipient will not know where someone works or goes to school. For example, a child is assaulted at school, or a shop assistant is assaulted at work:

• ‘Any School, Station Street, Anytown’ (good resolution, locatable).
• NOT ‘At school’ (not locatable).
• ‘Supermarket Name, Station Street, Anytown’ (good resolution, locatable).
• NOT ‘At work’ (not locatable).

Avoid unnecessary detail, such as the injured body part or the relationship to the perpetrator. For example:

NOT ‘Hit on head by brother’ (mechanism, injured body part and perpetrator are not needed here, not locatable).

If the assault happened at a private address, do not enter the address. Instead, enter “at home” or “at a friend’s home” as appropriate. This identifies the location of the assault without including identifiable data. 

Further information

• NHS England: Collecting violent injury data – Emergency Care Dataset (ECDS)v4 & Information Sharing to Tackle Violence (ISTV) Supporting guidance (PDF).
• NHS England. Introduction to violence reduction.
• Royal College of Emergency Medicine. Information Sharing to Tackle Violence (ISTV).

As emergency departments and UTCs are often the first point of contact with the NHS for someone who has been assaulted they represent a key point in identifying the population who are affected by violence.

ICBs in London have used this population to form the basis of population health profiles that characterize the demographics, health needs and utilization of those affected by assault as part of their work under the Serious Violence Duty.

The London Violence Reduction Unit has used this data to understand which emergency departments should host hospital based youth workers to support young people attending ED after an assault.

‘Hidden’ violence in Haringey identified through ISTV data

• Challenge: Police data alone was not capturing the full picture of violence in Haringey.
• Action: Analysis of Emergency Department (ISTV) data revealed previously unknown hotspots for assaults, particularly specific locations that had been missed.
• Impact: Evidence-based interventions (e.g., targeted support, increased patrols) contributed to a 17% reduction in overall violence over the medium to long-term, resulting in around 400 fewer victims.