Assaults Against ER Physicians and Staff Rising

New research shows a significant increase in emergency department violence, but there are strategies to address the problem.

Violence against ER physicians is pervasive and increasing, research released this week shows.

In a survey conducted for the American College of Emergency Physicians (ACEP), a majority of the 3,539 doctors polled said they had been the victims of workplace violence recently. About 62% of ER physicians reported being assaulted in the past year, with 24% saying they had been assaulted two to five times.

"The main point is this is a problem that is real, it is increasing, and unfortunately the results of this poll will not surprise any practicing physician," Vidor Friedman, MD, ACEP president-elect and an ER physician in Florida, said during a press conference Tuesday.

The press conference focused on research findings, solutions for violence in ERs, and the impact on patients who witness acts of violence.

In addition to the survey, "ACEP Emergency Department Violence Poll Research Results," unpublished research unveiled on Tuesday showed a significant increase in ER violence in Michigan.

The Michigan research compares survey data from 2005 and 2018. In 2005, about 28% of ER physicians surveyed said some form of violence had been perpetrated against them in the past year. In 2018, the figure had risen to 38% of ER physicians.

Physicians are not the only emergency department personnel enduring violent encounters, the lead author of the Michigan research said during Tuesday's press conference.

"Every job title had violence perpetrated against them. What we found is that the time you spend with the patient increases the chance that violence will be perpetrated against you," said Terry Kowalenko, MD, chair of emergency medicine at Beaumont Hospitals in Dearborn, Michigan.

The ACEP survey features several key findings:

• 71% of ER physicians reported witnessing an assault at work
   
• 97% of assailants were patients
   
• The most common administrative and security responses to physical assaults were to place a behavioral flag in the patient's medical chart (28%) or to have the patient arrested (21%)
   
• 27% of ER physicians reported sustaining an injury from a workplace assault
   
• The top five kinds of physical assaults were hit or slap (44%), spit (30%), punch (28%), kick (27%), and scratch (17%)
   
• About 80% of ER physicians reported that workplace violence reduces staff productivity, increases emotional trauma, and extends wait times
   
• The Number One suggestion (49%) to address ER violence was increasing security
   
• 69% of ER physicians reported that workplace violence has increased over the past five years

Solving the problem
 

Kowalenko said there are four approaches to addressing violence in emergency departments: hospital policies, environment changes, staff education, and legal.

• Policies related to violence in the ER should be clear and consistently enforced. This approach applies to policies that may seem indirectly related to violence such as rules governing how many visitors can see a patient at one time.
   
• Environmental factors include security, cameras, and "badging" in and out of an ER's treatment area.
   
• Education of staff should not be limited to reacting to violent situations. Training should include identifying potentially violent patients and strategies to defuse potentially violent situations.
   
• More than two dozen states have adopted laws that make assaulting a healthcare worker a felony. These laws make assaulting a healthcare worker equivalent to assaulting a police officer.

Friedman said ER physicians and other staff members should consider pressing charges after a patient assaults them.

"Healthcare workers underreport violence because we want to take care of people. We don't want to create more of a problem when one already exists, but we are enabling the problem to a certain extent," he said.

Impact on patients
 

In the ACEP survey, 77% of ER physicians reported that emergency department violence undermines patient care.

Patient care suffers when there is violence in an emergency department, Friedman said.

"Emergency room patients can be traumatized to the point where they leave without being seen or treated because they were exposed to acts of violence. It also increases wait times and distracts physicians and nurses from the other patients in the emergency department who need their care," he said.