November 6, 2018

In the ED, physicians are slapped, strangled, and even bitten. Here's what they want hospitals to do about it.

Daily Briefing

    Violent assaults against ED doctors are becoming more common, new survey data show, and doctors are calling on hospitals and states to adopt policies to protect them.

    Learn more: Get our latest research on point-of-care violence

    Most ED docs say violence is rising

    The American College of Emergency Physicians (ACEP) in August commissioned a survey of more than 3,500 physicians. It published the results last month.

    About 70% of ED physicians surveyed said instances of violent assaults—such as being punched, slapped, and spat on—have increased in the last five years, according to the survey.

    Almost half of respondents said they had been victims of workplace assaults, and more than one-quarter said they were assaulted, to the point of injury, at least once per year.

    Results from a separate survey of doctors in Michigan published in the Annals of Emergency Medicine show 22% of respondents were constantly fearful at work, up from 13% in 2005. 

    In addition, Bureau of Labor Statistics data show "intentional injury" by another individual increased from 6.4 per 10,000 hospital workers in 2011 to 9.0 per 10,000 workers in 2016. The rate of injury across the private industry is 1.7 per 10,000 workers.

    Of the ACEP respondents who experienced a workplace assault, 70% said their hospitals responded to the attacks. However, only 3% said hospital security pressed charges.

    Why patients assault doctors

    Leigh Vinocur, who's been a physician and ED administrator for more than 20 years and has been assaulted by a patient, said the ED can be a dangerous place to work, for a few reasons. "Patients coming to the [ED] are generally in a vulnerable and volatile state," she explains. "They're often on drugs or the victims of gang or domestic violence, or need to be in a psychiatric facility."

    However, Jeff Solheim, president of the Emergency Nurses Association and an ED nurse for more than 20 years, disputed the idea that assaults are done largely by patients who are unware of their actions because of substance misuse or mental health issues. "I had to tell a family that their father died, and the son pushed me against a wall and banged my head."

    How hospitals can protect ED docs

    Despite the increase in violence against ED doctors, Terry Kowalenko, an emergency physician and co-author of the Michigan survey, said, "[T]here is very little published on topics such as situational awareness, verbal de-escalation, self-protection techniques or weapons awareness for emergency physicians to use."

    ACEP is calling for states to make assaults against health care workers a felony. It is also advocating for better security in EDs, including the addition of metal detectors to prevent knife attacks and instances of gun violence. 

    Harrington Hospital in Massachusetts installed medical detectors and hand-held detectors after a vicious knife attack left a nurse with nerve damage, and has since confiscated "several guns and a thousands of knives," the Boston Globe reports.

    According to NBC News, working at a hospital that responds inadequately to assaults can create a "dilemma" for health workers that wish to provide quality care to patients, but don't want to fear for their lives at work.

    Solheim said, "I can't take care of someone else when I'm scared to be there" (Scher, NBC News, 10/2; Kowalczyk, Boston Globe, 10/2).

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