Underreported But Not Unimportant: ER Violence is a Problem, and Technology Can Help Fix It
When the word ‘hospital’ enters my mind (a frequent occurrence, considering my profession), I usually think about patient care. What happened to the patient? How can they be helped? Will they be receiving the appropriate medical care? These are the questions that probably pop into the heads of many, just like they do in mine.
What I don’t—or didn’t until a few weeks ago—think about is the harm that can occur inside a hospital. Emergency room (ER) doctors and nurses are pushed, shoved, hit, and even bitten, according to recent research, including a six-hospital study by Terry Kowalenko, M.D., the head of emergency medicine for the Royal Oak, Mich.-based Beaumont Health System, and an ongoing national survey by the Emergency Nurses Association (ENA). According to the latest figures from the ENA, between January 2010 and January 2011, more than half of ER nurses—53.4 percent—reported experiencing verbal abuse, and about 13 percent said they had encountered physical violence at work in the previous week.
The matter has gotten the attention of Michigan lawmakers. The Senate passed a bill in June that would make assaulting an on-duty health worker punishable by the same penalty as assaulting a police officer or a firefighter: up to four years imprisonment and a $5,000 fine. At least 26 states have passed similar laws, The Detroit News reported.
When I interviewed Dr. Kowalenko a few weeks ago, he told me that according to his research, workers in general have a higher threshold for what they would report as a ‘violent’ incident. Additionally, if you’re the person who reports everything, and another person reports nothing, it may look as if you’re the problem rather than there being problem in your healthcare setting. As such, the workplace violence has affected healthcare professionals’ ability to work in that environment, as some have left the emergency department, while several others considered leaving, Kowalenko found.
Despite its prevalence, violence in the emergency department (ED) does not have to be a foregone conclusion. Extra security training, metal detectors, making zero-tolerance policies more well-known, and violence prevention programs can all be positive steps to fixing this problem.
However, I was surprised when I read an article from this past February reporting that officials at the Los Angeles County/USC Medical Center pushed to have metal detectors removed from parts of county hospitals to make them more welcoming to patients in the newly competitive marketplace. The proposal came at a time when high-profile shootings were putting the nation on edge, and prompted emotionally-charged debates about the availability of assault weapons and the presence of armed officers in schools.
The county's director of health services, Mitchell Katz, told the Los Angeles Times at the time that metal detectors stigmatize poor patients and visitors and give the impression that the county facilities are dangerous. Security is paramount, but metal detectors aren't the best way to ensure that, he argued. Most other urban hospitals in L.A. County do not have the machines, relying on guards to provide safety, he said.
Agree to disagree. I’m under the opinion that health systems can and should develop a full-scale security approach that proactively reduces the threat of violence and appropriately responds to violence when it does occur, regardless of what metal detectors might “imply” about urban hospitals in L.A. County regarding safety.
And this is where technology can innovatively enter the equation. I wrote about one such strategy that organizations can deploy, in which Beaumont Health has engaged in a pilot with Reston, Va.-based Ekahau Inc., a provider of real-time location systems (RTLS). The security badge that Ekahau provides disengages—so if an employee pulls on it, it creates a trigger that alerts Beaumont’s security operations center. In the center, there is a map that locates that device, so hospital officials can dispatch to that floor immediately, but also give officers information if that badge is moving down the hall or to another room.
An employee who feels threatened pulls down on the badge’s panic switch, and his/her location appears on badges worn by employees near the incident. Ekahau’s wearable radio-frequency identification (RFID) badges offer proximity-based messaging via text, and operate over the existing wireless local area network (WLAN), eliminating the need for manual panic button presses, dialing and map look-ups.
There are other solutions out there as well—Forerun, a Waltham, Mass.-based provider of ED physician charting software has attempted to tackle the issue via its software solution by having a flagging mechanism built into the clinical display, and a documentation application that allows in one or two clicks for the respective/targeted parties with a predefined distribution list to be notified as to a concern such as a lab delay, a throughput problem, cleaning, or security.
All of this has made me think about things a little differently when I think about hospitals and healthcare professionals who are working to provide care in an unpredictable environment—certainly a mission full of pressure and stress. The hope is that these professionals now realize how important of an issue workplace violence is, and how reporting an incident can go a long way to fix this troubling situation.
I can’t put it any better than Tammy Duong, a medical resident in the psychiatric unit of the Los Angeles County/USC Medical Center, did in the Los Angeles Times article. "Just because it is a hospital," she said, "doesn't mean violence can't spill over."
