Violence in the emergency department puts patients and physicians at risk


The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day.

A new poll by the American College of Emergency Physicians (ACEP) shows that emergency department violence is increasing, and more must be done to protect doctors and emergency personnel as they work to care for the health and safety of millions of patients across the country.

Nearly half (47 percent) of emergency physicians report being physically assaulted, with more than 60 percent of those saying the attacks occurred in the past year. Nearly 7 in 10 say that emergency department violence has increased in the past 5 years.

Nearly a third (28 percent) of emergency physicians say they’ve been injured at work because of an assault. Yes, this is a clarion call to improve physician safety. But, violence in the emergency department puts patients at risk, too.

In fact, more than 80 percent say that violence in the ED harms patient care. Emergency patients that witness violence can be traumatized to the point that they leave without being seen/treated. And, these attacks contribute to increasing wait times, are a major distraction for ED staff, and results in less focus on other patients that desperately need to be treated.

Patients with medical emergencies deserve a place of care that is free of physical dangers and care from staff who are not distracted by patients or visitors with behavioral or substance-induced violent behavior.

While there is no single cause for emergency department violence, the poll shows that a majority of emergency physicians believe that at least half of the assaults are committed by people seeking drugs or under the influence of drugs or alcohol. Our nation’s mental health care crisis plays a role, too.

With nearly two in five attacks coming from psychiatric patients, it is worth noting that severe shortages of psychiatric beds and lack of intensive outpatient resources do not help. Patients with mental health issues can be left waiting for psychiatric beds for hours and even days in the ER, a time bomb waiting to go off.

We’d like to say we are turning the corner and that more of these incidents are being met with consequences. That’s far from the case. Seven in 10 emergency physicians who were assaulted say that their hospital administration or security did report the incident, yet only 3 percent say the hospital pressed charges. There are steps that can be taken.

Nearly half of the physicians responding to the ACEP poll said that increasing security is the most important thing that hospitals can do to increase safety in the emergency department.  Hospitals could add security guards and cameras, as well as metal detectors and provide increased visitor screening inside hospitals, especially in emergency departments.

Security also can be bolstered by controlling access to the emergency room and between the emergency department and other areas of the hospital. Some hospitals use coded badges or wristbands for patients and visitors.

Some hospitals place “panic buttons” in key locations to speed up security response times and help make staff feel safe and have direct phone lines to hospital security or to local police departments.

Emergency departments should have plans in place for managing potentially violent situations. This plan should include who responds, a team leader, each person’s responsibility (including the team leader), and the steps that should be taken to respond.

It should also be incumbent on every hospital administration to respond to incidents.

Emergency physicians are getting kicked, spat on and punched while they try to do their jobs. But, the challenges are not limited to physical violence. In today’s “me too” era, it is unconscionable that nearly all women who are emergency physicians (96 percent) reported that a patient or visitor made inappropriate comments or unwanted advances toward them. They are not alone, as 80 percent of men reported the same.

ACEP supports federal and state-level efforts to strengthen protections for emergency physicians and personnel. We have to do better and improve violent scenario training, prevention, and de-escalation strategies and situational awareness. Emergency physicians must become experts in how to recognize potentially violent patients early and be familiar with the most efficient way to get help, before incidents occur.

Physicians, hospitals, and policymakers have to work together to make sure that workplace violence is no longer part of our job description.

Vidor E. Friedman is president-elect, American College of Emergency Physicians.

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