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Yücel Özden KB, Sarıca Çevik H, Asenova R, Ungan M. Guardians of health under fire: Understanding and combating violence against doctors. Aten Primaria 2024; 56:102944. [PMID: 38678853 PMCID: PMC11066614 DOI: 10.1016/j.aprim.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Violence against physicians is not a newly emerged but an increasingly serious problem. Various studies have reported a prevalence of up to 90%. If not prevented, it not only causes physical and mental harm to physicians who are dedicated to serving humanity but also affects the entire healthcare system and, consequently, the whole community with its direct and indirect effects. Some interventions have a positive outcome when effectively managed. However, for these interventions to be permanent and effective, they need to be multidisciplinary, legally backed and adopted as public policy. In this article, the prevalence of violence against physicians in the literature, its causes, practices worldwide, and suggestions for solving this problem are compiled.
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Affiliation(s)
| | - Hüsna Sarıca Çevik
- Ankara University School of Medicine, Department of Family Medicine, Ankara, Turkey.
| | - Radost Asenova
- Medical University of Plovdiv, Department of Urology and General Medicine, Plovdiv, Bulgaria
| | - Mehmet Ungan
- Ankara University School of Medicine, Department of Family Medicine, Ankara, Turkey
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Cruz-Kan K, Dufault B, Fesehaye L, Kornelsen J, Hrymak C, Zubert S, Ratana P, Leeies M. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. CAN J EMERG MED 2023; 25:617-626. [PMID: 37389771 DOI: 10.1007/s43678-023-00533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. METHODS We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. RESULTS A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. CONCLUSIONS Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.
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Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lula Fesehaye
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Jodi Kornelsen
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Shelly Zubert
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
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Recsky C, Moynihan M, Maranghi G, Smith OM, PausJenssen E, Sanon PN, Provost SM, Hamilton CB. Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review. J Emerg Nurs 2023:S0099-1767(23)00059-4. [PMID: 37074250 DOI: 10.1016/j.jen.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION This is a rapid review of the published evidence on the effectiveness of interventions for mitigating workplace violence against staff in hospital emergency departments. Focused on the specific needs of an urban emergency department in Canada, this project sought to address the question, "What interventions have evidence regarding effectiveness for addressing workplace patient/visitor violence toward staff in the emergency department?" METHODS Following Cochrane Rapid Review methods, 5 electronic databases (MEDLINE via PubMed, Cochrane CENTRAL, Embase, PsycINFO, CINAHL) and Google Scholar were searched in April 2022 for intervention studies to reduce or mitigate workplace violence against staff in hospital emergency departments. Critical appraisal was conducted using Joanna Briggs Institute tools. Key study findings were synthesized narratively. RESULTS Twenty-four studies (21 individual studies, 3 reviews) were included in this rapid review. A variety of strategies for reducing and mitigating workplace violence were identified and categorized as single or multicomponent interventions. Although most studies reported positive outcomes on workplace violence, the articles offered limited descriptions of the interventions and/or lacked robust data to demonstrate effectiveness. Insights from across the studies offer knowledge users information to support the development of comprehensive strategies to reduce workplace violence. DISCUSSION Despite a large body of literature on workplace violence, there is little guidance on effective strategies to mitigate workplace violence in emergency departments. Evidence suggests that multicomponent approaches targeting staff, patients/visitors, and the emergency department environment are essential to addressing and mitigating workplace violence. More research is needed that provides robust evidence on effective violence prevention interventions.
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Gupta S, Williams K, Matile J, Milne N, Smith O, Snider C, Vaillancourt S. Trends in the role of security services in the delivery of emergency department care. CAN J EMERG MED 2023; 25:43-47. [PMID: 36409449 DOI: 10.1007/s43678-022-00406-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Security services in most settings are an essential part of emergency department (ED) care, but their role remains poorly understood. We sought to:(1) identify the frequency of security services involvement in ED care;(2) characterise the events security services are called for; and (3) identify temporal trends in use. METHODS We used a hospital-wide security database at a tertiary care ED in downtown Toronto, Ontario. Data from January 2017 to June 2021 related to the ED, patient or visitor related safety calls were included. We categorised calls by type of event (e.g.: Code White or Restraints). Call numbers were calculated as rates to adjust for visit volumes for each period. Univariate analyses were used to assess association between security services' calls and shift time, day of week, and month of the year. RESULTS Over the 4.5-year study period, 20,033 ED-related calls were recorded. On average, we identified 61 calls per 1000 patient visits. On univariate analysis, no increase in security calls were found based on day of week or month, but a disproportionate number of security calls were recorded overnight. CONCLUSION This study reveals high security services involvement in the delivery of care in one urban ED. Security databases can inform improvement work and could be augmented by better coding of violent events and linkage with electronic health records when involving patients.
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Affiliation(s)
- Sahil Gupta
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. .,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Kenneth Williams
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Matile
- Security Services, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Noreen Milne
- Security Services, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Orla Smith
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Carolyn Snider
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Samuel Vaillancourt
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
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Emergency department leadership considerations for the next phase of the COVID-19 pandemic. CAN J EMERG MED 2023; 25:110-114. [PMID: 36689189 PMCID: PMC9869826 DOI: 10.1007/s43678-022-00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 01/24/2023]
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Xie EC, Chan K, Khangura JK, Koh JJK, Orkin AM, Sheikh H, Hayman K, Gupta S, Kumar T, Hulme J, Mrochuk M, Dong K. CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary. CAN J EMERG MED 2022; 24:369-375. [PMID: 35389188 PMCID: PMC8988109 DOI: 10.1007/s43678-022-00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Edward C Xie
- Department of Family & Community Medicine, Division of Emergency Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada. .,Emergency Department, RFE Building, Toronto General Hospital, Toronto, ON, Canada.
| | - Kathryn Chan
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Jaspreet K Khangura
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Jek-Kahn Koh
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aaron M Orkin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Joseph's Health Centre, Unity Health Toronto, Inner City Health Associates, Toronto, ON, Canada
| | - Hasan Sheikh
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sahil Gupta
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Thara Kumar
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,Medical Officer of Health, Central Zone, Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
| | - May Mrochuk
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,B804 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
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Revue E, Boyle A, Chauvin A, Atkinson P. Violence in emergency care: can we do better? CAN J EMERG MED 2022; 24:107-108. [PMID: 35258813 DOI: 10.1007/s43678-021-00216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Eric Revue
- Emergency Department and PreHospital EMS, Lariboisière's Hospital, Assistance Publique Hôpitaux de Paris, Paris University, Paris, France. .,Service d'Accueil Des Urgences/SMUR, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France.
| | - Adrian Boyle
- Emergency Department, Addenbrookes Hospital, Cambridge, England
| | - Anthony Chauvin
- Emergency Department and PreHospital EMS, Lariboisière's Hospital, Assistance Publique Hôpitaux de Paris, Paris University, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John, NB, Canada
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