As those of you who follow this blog know, I recently gave a severe thrashing to a hospital which got security all wrong. That hospital, based in the Las Vegas metro, attempted to prepare staffers for violence by sending an armed man in, unannounced, to conduct a ficitious terrorist attack on the staff. (Yeah, brilliant.)
Foolish behavior like the above aside, no one questions that hospital violence is a real and growing problem. The most recent authority to weigh in is no other than the Joint Commission, which notes in its latest Sentinel Event Alert that hospitals “are being confronted with steadily increasing rates of crime, including assault, rape and murder.” Extremely sobering stuff.
The standards group has developed a list of 13 steps hospitals can take to prevent violence in their facilities, such as doing a thorough risk assessment for your facility, putting extra security precautions in place in the ED and doing careful background checks on potential employees. My guess is that while most hospitals are taking some of these steps, few have developed a really comprehensive program like the one the Joint Commission has in mind.
You don’t have to be a security expert to conclude that hospitals need to confront this issue. But striking the right balance is going to be a serious challenge; after all, if your hospital’s security checkpoint resembles that found at the local airport, patients may well go elsewhere. All in all, there’s no easy answers here.
I am the author of a recently-published book, Violence in the Emergency Department: Tools and Strategies to Create a Violence-Free ED (Springer Publishing, NYC) and a consultant in the field. I am very pleased that the Joint Commission has weighed in on the topic of hospital – and specifically ED violence. I agree with you that many hospitals have taken a few steps toward rectifying gaps, but do not have a comprehensive prevention plan in place – and need to. And yes, it is a delicate balance! But there are several must-do’s that EDs can implement to protect its staff, its patients and the hospital’s reputation and bottom line. Please email me at http://www.EDviolence. com. Thank you. Nikki Allen
Nikki:
Thank you very much for your perspective on this issue.
Now, a question for you and all readers of this blog.
When I looked at the numbers the Joint Commission cited regarding hospital violence, the number of reported incidents seemed very low, statistically. (As I recall we were talking about say, 30 to 50 incidents per year in a few major categories of violent incident.) The JC noted that it believed such incidents are substantially under-reported.
How much higher do you think the “real” numbers would be, if every incident were documented and reported?
There is no way to know precisely of the actual numbers of ED violence incidents that are actually occurring in US ED’s. However, I agree 100% with the Joint Commission’s assessment. As an example, I subscribe to many news feeds but still have to dig to find out about violence incidents that are occurring. (I have asked to speak on several of the major networks about the topic of ED Violence but I have been denied.) Recently I spoke to a group of ED physicians and nurses and attempted to answer the question of reported incidents Vs actual incidents. I located 3 incidents of stabbings in ED that were “buried” in the bylines of websites…never reported via major news vehicles, to my knowledge. I am baffled. One reason for underreporting that greatly concerns me is that hospital administration does not appear to recognize ED violence as one of the top 10 issues with which they must confront in the next 5 years (ACHE-American College of Healthcare Executives survey). I think that as ED leaders, it is up to us to communicate concerns and solutions to hospital administrators regarding ED violence – and establish a business case for ED violence prevention.
“Establishing a business case for ED violence prevention” — that phrase strikes me as a VERY compelling article topic. Would you be interested in contributing a brief piece on the subject to this blog? (We’d also promote it on nextHospital, our LinkedIn group, whose audience is dead-on for your message.) If you’re interested, please shoot me an e-mail and we’ll hash something out.