Hospital Violence Need Not Be ‘Part of the Job’

This article first appeared February 27, 2018 on MedPage Today.

Salynn Boyles, Contributing Writer

SAN ANTONIO — Hospital staffers have a higher risk for experiencing workplace violence than workers in any other industry, but many of the most vulnerable just accept it as an unavoidable part of the job.

The fact that in-hospital violence is often not reported by staffers may be contributing to the problem, critical care surgeon Lewis J. Kaplan, MD, said Tuesday in a presentation to the Society of Critical Care Medicine’s 47th Critical Care Congress.

Kaplan, who spent five years embedded with Connecticut’s South Central Regional SWAT team as a medical team member, said that hospitals can be dangerous places to work, but proper planning and training can reduce the risk related to violence.

Joint Commission: 3 Tips on Preventing Workplace Violence

Putting New Strategies in Place to Decrease Workplace Violence

According to the U.S. Bureau of Labor Statistics, in 2015, there were 8.5 injuries due to violence encountered on the job among every 10,000 full-time hospital workers, compared to 1.7 cases for all other private industry, Kaplan said.

He added that attacks on healthcare workers in hospitals account for almost 70% of all nonfatal workplace assaults.

“In-hospital violence is very much underreported, so we don’t know the real figures,” Kaplan told MedPage Today. “The emergency department is the most common setting for workplace violence, but it is not limited to the ED. Social workers, cases managers, advanced practice providers are all vulnerable.”

In a nationally representative survey of several hundred emergency medicine physicians published in 2011, 75% reported experiencing verbal abuse in the previous year and 21% reported physical abuse. In a similar survey, 100% of nurses working in emergency departments reported experiencing verbal abuse and 82% reported experiencing physical abuse.

“Tolerance of this behavior is considered to be part of the job, but the tolerance allows it to continue,” Kaplan said. “The problem is that when you tolerate one thing it opens the door for another. Verbal abuse is a risk factor for battery.”

Kaplan said underreporting of workplace violence leads to missed opportunities for mitigation and prevention.

Perpetrator restraint, rapid intervention teams, and de-escalation have all been proven to be effective strategies for reducing in-hospital violence.

The Veterans Affairs system has instituted a program that includes de-escalation training and “therapeutic containment” (safely restraining perpetrators), along with preparedness training, which helps staffers spot specific threats.

“When you say in-hospital violence, most people’s minds go straight to the active shooter situation, but the vast majority of violent episodes occur between patients or families and healthcare workers,” Kaplan explained.

He said hospital staffers need to be trained to identify the potential for violence committed by patients, their family members or visitors, as well as identify strategies for de-escalating events and escaping them.

Therapeutic containment training is useful “but not that many people get it,” Kaplan said, adding that training should also involve security staff.

“And all staff, including security personnel, should be trained on how to stop bleeding in those injured; and medical supplies, including tourniquets, hemolytic gauze and other blood-loss prevention materials should be readily available on every floor, not just the emergency department or operating room.”