Patients visiting an Emergency Department (ED) due to violence who are unable or unwilling to disclose that their injury is violence-related are unlikely to receive support for associated psychosocial vulnerabilities. Nurse-led hospital-based violence intervention programmes (HVIPs) are an additional resource in ED providing support to patients exposed to violence. Our objective was to determine whether HVIPs can overcome barriers to disclosure and what patient characteristics are associated with non-disclosure under usual care.

A natural longitudinal experiment, including routine health data from 2012 to 2024, comparing intervention EDs with HVIPs to control EDs.

Multi-level logistic difference-in-difference models with unplanned visits clustered by patient on the probability that a visit ( N  = 6,724,446) was recorded as violence-related in ED or subsequently in HVIP data from Wales, UK: nine control EDs without an HVIP were compared with two intervention sites with nurse-led HVIPs. Secondary analyses assessed the characteristics of patients disclosing to the HVIP, but not under usual care by age, gender, ethnicity, and residential deprivation.

The probability that a visit was designated as assault-related increased in intervention EDs following HVIP implementation (Cardiff β = 0.37, 95 % CI 0.31 to 0.44; Swansea β = 0.19, 95 % CI 0.14 to 0.25). Male, younger, those residing in deprived neighbourhoods, and black or mixed ethnicity patients were more likely to be missed under usual care.

Non-disclosure is a significant barrier in provisioning support to those who are psychosocially vulnerable and likely to revisit ED. Nurse-led HVIPs can overcome inequalities in ED, reaching patient groups that are not otherwise able or willing to disclose their exposure to violence. HVIPs offer the prospect of reducing inequality in patients' visiting ED due to violence.

ISRCTN Registration: 68945844 (12 August 2022).

Many of those exposed to violence can transfer directly to the Emergency Department (ED) and are unknown to law enforcement and affiliated services. ED is uniquely placed to provide patients with support for psychosocial vulnerabilities associated with violence and repeat visits to ED. Evidence from health and allied fields document a reluctance for some patients to disclose their exposure to violence. It is not known whether the implementation of nurse-led Hospital Violence Intervention Programmes (HVIPs) in ED can overcome barriers to disclosure in ED.

Nurse-led HVIPs in ED, working as part of the clinical team, can identify violence-related visits not otherwise captured under usual care and therefore address inequalities in emergency healthcare. Those missed under usual care are typically male, younger, black or mixed ethnicity and live in more deprived neighbourhoods.

Policies aiming to address inequality in the health service response to violence can be supported through nurse-led HVIPs in ED.