1
|
Klein L, Hoffman S, Decena EF, Eckardt P, Tomkin T, DeVoe D, Gaeta L, Raio CC. Emergency Department Utilization of Physical Restraints: A Study of Documentation Compliance and Adverse Events. Am J Emerg Med 2024:S0735-6757(24)00515-1. [PMID: 39368862 DOI: 10.1016/j.ajem.2024.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 09/27/2024] [Indexed: 10/07/2024] Open
|
2
|
Rabin S, Akinfemiwa O, Bradley M, Clayton GC, Cozzi N, Gottlieb M. Protecting Frontline Workers: Strategies for Preventing and Mitigating Violence in the Emergency Department. Ann Emerg Med 2024:S0196-0644(24)00357-3. [PMID: 39093246 DOI: 10.1016/j.annemergmed.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024]
Abstract
Violence in the emergency department (ED) has been escalating for decades worldwide. High-stress situations are commonplace in the ED and can lead to intentional and unintentional aggression from patients. Staff must be educated on the signs of violence and escalation to recognize potentially dangerous situations early. Staff must also identify underlying medical conditions as the source of unintentional violence. Both situations would require different approaches to management. ED violence negatively affects patient care and leads to long-term harmful outcomes for staff. Multiple strategies for mitigation and prevention have been explored in the literature. Among those, weapon detection systems, de-escalation training, and violence prevention programs have demonstrated improved staff outcomes and decreased violence. Formalized procedures and policies should clearly assign roles for each staff member in the event of a violent patient. Training programs should be instituted and may include self-defense classes or crisis intervention courses. Emergency medicine residency programs and EDs around the country must address the rising incidence of violence within EDs through interdisciplinary policy, procedure development, and prevention and mitigation programs.
Collapse
Affiliation(s)
- Sabrina Rabin
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Ololade Akinfemiwa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Miranda Bradley
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | | | - Nicholas Cozzi
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| |
Collapse
|
3
|
Ahluwalia T, Singh S, Gandhi N, Toy S, Douglass K, Blanchard J, Davey K. Violence in the emergency department: a quantitative survey study of healthcare providers in India. Int J Emerg Med 2024; 17:83. [PMID: 38961384 PMCID: PMC11223359 DOI: 10.1186/s12245-024-00653-x] [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: 02/05/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Workplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WPV in healthcare, most of the existing research has been conducted in developed countries with established laws and repercussions for violence against healthcare providers. More data on WPV against ED providers practicing in low-resource settings is necessary to understand these providers' unique challenges. OBJECTIVE This study aims to gain insight into the incidence and characteristics of WPV among ED healthcare providers in India. METHODS This study was conducted at two EDs in geographically distinct regions of India. A survey was designed to assess violence in EDs among healthcare providers. Surveys were distributed to ED workplace providers, completed by hand, and returned anonymously. Data was entered and stored in the RedCAP database to facilitate analysis. RESULTS Two hundred surveys were completed by physicians, nurses, and paramedics in Indian EDs. Most reported events involved verbal abuse (68%), followed by physical abuse (26%), outside confrontation (17%), and stalking (5%). By far, the most common perpetrators of violence against healthcare workers were bystanders including patient family members or other accompanying individuals. Notably, reporting was limited, with most cases conveyed to ED or hospital administration. CONCLUSION These results underscore the prevalence of WPV among Indian ED healthcare providers. High rates of verbal abuse followed by physical abuse are of concern. Most perpetrators of WPV against healthcare providers in this study were patient family members or bystanders rather than the patients themselves. It is imperative to prioritize implementing prevention strategies to create safer work environments for healthcare workers.
Collapse
Affiliation(s)
- Tania Ahluwalia
- Children's National Health System, Division of Emergency Medicine, 111 Michigan Avenue, Washington, DC, 20010, USA.
| | | | - Navvin Gandhi
- Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Serkan Toy
- Departments of Basic Science Education & Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katherine Douglass
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Janice Blanchard
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kevin Davey
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| |
Collapse
|
4
|
van Amsterdam J, van den Brink W. Combined use of cocaine and alcohol: A violent cocktail? A systematic review. J Forensic Leg Med 2023; 100:102597. [PMID: 37832170 DOI: 10.1016/j.jflm.2023.102597] [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: 05/16/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents. In the current systematic review, available data from human studies on the relation between cocaine and violent behaviour is presented. In particular, we present scientific data on the acute induction of violence by cocaine alone, as well as, that by the combination of cocaine and alcohol known to be frequently used simultaneously. RESULTS: show that there is only weak scientific evidence for the acute induction of violent behaviour by cocaine, either when used alone or in combination with alcohol. Based on these data we were also able to refute misconceptions about the relation between cocaine and violence published in the popular press and governmental reports, because it appeared that there was hardly any empirical support for this widely shared opinion. Probably, contextual factors, including cocaine use disorder and personality disorder, may better explain the assumed association between cocaine and violence.
Collapse
Affiliation(s)
- Jan van Amsterdam
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Gallen K, Sonnenberg J, Loughran C, Smith MJ, Sheppard M, Schuster K, Kaufman E, Song JS, Hall EC. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities 2023; 10:870-882. [PMID: 35267188 DOI: 10.1007/s40615-022-01275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Law enforcement activity, in the form of outside agencies or hospital security forces, is increasingly common in American healthcare. Little is known about the potential effects of this prevalent, modifiable exposure on hospital staff and patient health. This narrative review characterizes existing evidence on the direct and indirect health effects of law enforcement activity in hospitals. OBSERVATIONS Law enforcement activity in hospitals can affect health outcomes through four mechanisms: (1) physical health effects related to workplace violence, restraint use, excessive force, and weapon use; (2) mental health effects involving perceptions of safety and psychological distress; (3) social effects related to the patient-provider relationship, mistrust, and bias and discrimination; and (4) legal and ethical considerations affecting overall well-being. CONCLUSIONS AND RELEVANCE Unchecked law enforcement activity in hospitals may risk patient physical and mental health, reduce patient trust, result in bias and discrimination, and contribute to legal and ethical rights violations. Importantly, law enforcement activity in hospitals may also contribute to staff perceptions of safety. To fill knowledge gaps on the measurable impact of law enforcement activity in the hospital on staff and patients, hospitals should collect and publicly share robust data on law enforcement activity in their facilities, create and adopt patient-centered policies to ensure safety and protect patient health and privacy, and implement evidence-based interventions that safely reduce law enforcement involvement with patients.
Collapse
Affiliation(s)
- Kate Gallen
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Kirsten Schuster
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ji Seon Song
- School of Law, University of California, Irvine, CA, USA
| | - Erin C Hall
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
| |
Collapse
|
6
|
Cybulska AM, Weymann A, Rachubińska K, Grochans S, Wójcik G, Grochans E. Factors Associated with Insomnia and Aggression among Healthcare Workers during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1433. [PMID: 36674188 PMCID: PMC9859312 DOI: 10.3390/ijerph20021433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
(1) Healthcare workers are exposed to increased risks of insomnia and aggression during the COVID-19 pandemic. The aim of the study was to assess insomnia, sleep disturbances, and aggression and identify the associated risk factors among healthcare workers during the COVID-19 pandemic. (2) A total of 264 healthcare workers participated in the study. The study was conducted with the diagnostic survey method, using the Buss−Perry Aggression Questionnaire, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index, and a self-administered questionnaire. (3) The vast majority of the respondents (81.06%) suffered from insomnia and had poor sleep quality (78.03%). Education (p = 0.038), marital status (p = 0.043), and working with patients suffering from COVID-19 (p = 0.024) were statistically significant contributors to insomnia. Age was found to significantly correlate with total aggression (r = −0.133 p = 0.031), verbal aggression (r = −0.138 p = 0.025), and anger (r = −0.151 p = 0.014). The analysis demonstrated statistically significant relationships between gender and physical aggression (p = 0.017), anger (p = 0.032), and hostility (p = 0.002). A statistically significant positive correlation between the quality of sleep as per the PSQI and all subscales of the BPAQ was found (p < 0.001). (4) A considerable proportion of HCWs experienced sleep disturbances during the outbreak, stressing the need to establish ways to reduce long-term adverse outcomes associated with chronic insomnia and mental health problems and adjust interventions under pandemic conditions.
Collapse
Affiliation(s)
- Anna Maria Cybulska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Agnieszka Weymann
- Independent Clinical Public Hospital No. 2 in Szczecin, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 72-111 Szczecin, Poland
| | - Kamila Rachubińska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Szymon Grochans
- Department of Clinical Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Grzegorz Wójcik
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| |
Collapse
|
7
|
Jin RO, Anaebere TC, Haar RJ. Exploring Bias in Restraint Use: Four Strategies to Mitigate Bias in Care of the Agitated Patient in the Emergency Department. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:100-105. [PMID: 37205039 PMCID: PMC10172532 DOI: 10.1176/appi.focus.23022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Agitation is a routine and increasingly common presentation to the emergency department (ED). In the wake of a national examination into racism and police use of force, this article aims to extend that reflection into emergency medicine in the management of patients presenting with acute agitation. Through an overview of ethicolegal considerations in restraint use and current literature on implicit bias in medicine, this article provides a discussion on how bias may impact care of the agitated patient. Concrete strategies are offered at an individual, institutional, and health system level to help mitigate bias and improve care. Reprinted from Acad Emerg Med 2021; 28:1061-1066, with permission from John Wiley & Sons. Copyright © 2021.
Collapse
Affiliation(s)
- Rowen O. Jin
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California, USA (Jin). Special Projects and Innovation, Emergency Medicine Residency Program, Dignity Health–St. Joseph’s Medical Center, Stockton, California, USA (Anaebere). Department of Epidemiology and Biostatistics, University of California at Berkeley, Berkeley, California, USA (Haar)
| | - Tiffany C. Anaebere
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California, USA (Jin). Special Projects and Innovation, Emergency Medicine Residency Program, Dignity Health–St. Joseph’s Medical Center, Stockton, California, USA (Anaebere). Department of Epidemiology and Biostatistics, University of California at Berkeley, Berkeley, California, USA (Haar)
| | - Rohini J. Haar
- Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California, USA (Jin). Special Projects and Innovation, Emergency Medicine Residency Program, Dignity Health–St. Joseph’s Medical Center, Stockton, California, USA (Anaebere). Department of Epidemiology and Biostatistics, University of California at Berkeley, Berkeley, California, USA (Haar)
| |
Collapse
|
8
|
García-Zamora S, Pulido L, Miranda-Arboleda AF, García DE, Pérez G, Priotti M, Chango DX, Antoniolli M, Zaidel EJ, Lopez-Santi R, Vazquez G, Nuñez-Mendez R, Cabral LT, Sosa-Liprandi Á, Liblik K, Baranchuk A. Aggression, Micro-aggression, and Abuse Against Health Care Providers During the COVID-19 Pandemic. A Latin American Survey. Curr Probl Cardiol 2022; 47:101296. [PMID: 35779676 PMCID: PMC9239921 DOI: 10.1016/j.cpcardiol.2022.101296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has had tremendous consequences globally. Notably, increasing complaints of verbal and physical violence against health care providers have been reported. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022 to delineate the violent behavior against front-line health professionals in Latin America. A total of 3544 participants from 19 countries were included. There were 58.5% women, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members. About 54.8% reported acts of abuse: 95.6% verbal abuse, 11.1% physical abuse, and 19.9% other types. Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, 56.2% considered changing their care tasks, and 33.6% considered quitting their profession. In a logistic regression model, nurses (odds ratio (OR) 1.90, P < 0.001), doctors (OR 2.11, P < 0.001), and administrative staff (OR 3.53, P = 0.005) experienced more abuse than other health workers. Women more frequently reported abuse (OR 1.56, P < 0.001), as well as those who worked directly with COVID-19 patients (OR 3.66, P < 0.001). A lower probability of abuse was observed at older ages (OR 0.95, P < 0.001). There has been a high prevalence of abuse against health personnel in Latin America during the COVID-19 pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be at elevated risk. It is imperative to develop strategies to mitigate these acts and their repercussions on the patient-provider relationship and outcomes.
Collapse
Affiliation(s)
| | - Laura Pulido
- Asociación Argentina de Medicina Respiratoria (AAMR), Buenos Aires, Argentina
| | - Andrés Felipe Miranda-Arboleda
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada; Cardiology Department, Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - Darío Eduardo García
- Hospital de Alta Complejidad en Red "El Cruce", Buenos Aires, Argentina; Federación Latinoamericana de Medicina de Emergencias (FLAME), Buenos Aires
| | - Gonzalo Pérez
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Mauricio Priotti
- Cardiology Department, Delta Clinic, Rosario, Santa Fe, Argentina
| | - Diego X Chango
- Cardiology and Advanced Cardiac Imaging Division, Hospital Universitario del Río, Cuenca, Azuay, Ecuador
| | | | - Ezequiel José Zaidel
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ricardo Lopez-Santi
- Division of Cardiology, Hospital Italiano de La Plata, Buenos Aires, Argentina
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rodrigo Nuñez-Mendez
- Asociación de Residentes y Fellows de Cardiología de México A. C. (ARCAME), México
| | - Luz Teresa Cabral
- Cardiology Department, Hospital Nacional de Itaguá, Itaguá, Paraguay
| | - Álvaro Sosa-Liprandi
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
9
|
Slack RJ, French C, McGain F, Bates S, Gao A, Knowles S, Yang Y. Violence in intensive care: a point prevalence study. CRIT CARE RESUSC 2022; 24:272-279. [PMID: 38046215 PMCID: PMC10692600 DOI: 10.51893/2022.3.oa7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Violence in the intensive care unit (ICU) is poorly characterised and its incidence is largely extrapolated from studies in the emergency department. Policy requirements vary between jurisdictions and have not been formally evaluated. Methods: A multisite, single-time point observational study was conducted across Australasian ICUs which focused on the incidence of violence in the previous 24 hours, the characteristics of patients displaying violent behaviour, the perceived contributors, and the management strategies implemented. Unit policies were surveyed across a range of domains relevant to violence management. Results: Data were available for 627 patients admitted to 44 ICUs on one of 2 days in June 2019. Four per cent (25/627) displayed at least one episode of violent behaviour in the previous 24 hours. Violent behaviour was more likely in individuals after a greater length of stay in hospital (incidence, 2%, 4% and 7% for day 0-2, 3-7 and > 7 days respectively; P = 0.01) and in the ICU (2%, 4% and 9% for day 0-2, 3-7 and > 7 of ICU stay respectively; P < 0.01). The most common perceived contributors to violence were confusion (64%), physical illness (40%), and psychiatric illness (34%). Management with chemical sedation (72%) and physical restraint (28%) was commonly required. Clinicians assessed an additional 53 patients (53/627, 9%) as at risk of displaying violence in the next 24 hours. Of the 44 participating ICUs, 30 (68%) had a documented violence procedure. Conclusion: Violence in the ICU was common and frequently required intervention. In this study, one-third of ICUs did not have formal violence procedures, and in those with violence procedures, considerable variation was observed.
Collapse
Affiliation(s)
| | - Craig French
- Western Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC, Australia
| | | | - Samantha Bates
- Western Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Annie Gao
- The George institute for Global Health, Sydney, NSW, Australia
| | - Serena Knowles
- The George institute for Global Health, Sydney, NSW, Australia
| | - Yang Yang
- Western Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC, Australia
- Monash University, Melbourne, Victoria, Australia
| | - For the George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG)
- Western Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC, Australia
- The George institute for Global Health, Sydney, NSW, Australia
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Sabak M, Al-Hadidi A, Oktay MM, Al B, Kazaz T, Kowalenko T, Hakmeh W. Workplace Violence in Emergency Departments in Turkey. Avicenna J Med 2021; 11:111-117. [PMID: 34646787 PMCID: PMC8500074 DOI: 10.1055/s-0041-1732284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
Studies on workplace violence against physicians in emergency departments (EDs) in Turkey are lacking.
Methods
To describe the frequency and types of workplace violence, a 34-question online survey of the past 12 months was sent to physicians working in EDs in Turkey. Types of violence were categorized as verbal threats, physical assaults, confrontation, stalking, and sexual harassment.
Results
A total of 366 physicians completed the survey; 4 were excluded (minimum 20 hours/week). Sixty-two percent of respondents were men. Ninety-nine percent reported verbal abuse and 54% reported physical violence. Family members, not patients, were the most common perpetrators of every form of workplace violence. Hospitals limiting the number of visitors and loitering had 14% reduction in physical threats. Only 23% of respondents indicated that their hospital offered information about preventing and managing workplace violence even though 86% noted interest. Only 1% never had fear, even though 89% indicated they had security staff. Over 89% felt that hospital security was lacking in number and ability to protect. For 82%, workplace violence affected their ability to provide patient care. Ninety percent indicated that current laws do not adequately protect them. There was also no statistically significant difference in any type of workplace violence based on the timing or length of shifts, type of hospital, or number of hours worked. Of all types of violence reported, only stalking demonstrated a statistically significant difference between men and women.
Conclusion
Workplace violence is a real danger for physicians working in EDs in Turkey, similar to other countries, demonstrating that this problem transcends borders. Further studies should assess root causes of violent behaviors of patients and their visitors, as well as possible (administrative, social, and legal) mechanisms to minimize such violence. Hospitals that limited the number of visitors and empowered security officers were associated with decreased violence.
Collapse
Affiliation(s)
- Mustafa Sabak
- Department of Emergency Medicine, University of Gaziantep School of Medicine, Gaziantep, Turkey
| | - Ameer Al-Hadidi
- Department of Surgery, Beaumont Health, Royal Oak, Michigan, United States
| | - Mehmet Murat Oktay
- Department of Emergency Medicine, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Behcet Al
- Department of Emergency Medicine, University of Gaziantep School of Medicine, Gaziantep, Turkey
| | - Tanyeli Kazaz
- Department of Emergency Medicine, University of Gaziantep School of Medicine, Gaziantep, Turkey
| | - Terry Kowalenko
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Wael Hakmeh
- Department of Emergency Medicine, University of Gaziantep School of Medicine, Gaziantep, Turkey
| |
Collapse
|
11
|
Jin RO, Anaebere TC, Haar RJ. Exploring bias in restraint use: Four strategies to mitigate bias in care of the agitated patient in the emergency department. Acad Emerg Med 2021; 28:1061-1066. [PMID: 33977591 DOI: 10.1111/acem.14277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
Agitation is a routine and increasingly common presentation to the emergency department (ED). In the wake of a national examination into racism and police use of force, this article aims to extend that reflection into emergency medicine in the management of patients presenting with acute agitation. Through an overview of ethicolegal considerations in restraint use and current literature on implicit bias in medicine, this article provides a discussion on how bias may impact care of the agitated patient. Concrete strategies are offered at an individual, institutional, and health system level to help mitigate bias and improve care.
Collapse
Affiliation(s)
- Rowen O. Jin
- Department of Emergency Medicine LAC+USC Medical Center Los Angeles California USA
| | - Tiffany C. Anaebere
- Special Projects and Innovation Emergency Medicine Residency Program Dignity Health–St. Joseph’s Medical Center Stockton California USA
| | - Rohini J. Haar
- Department of Epidemiology and Biostatistics University of California at Berkeley Berkeley California USA
| |
Collapse
|
12
|
|
13
|
Davey K, Ravishankar V, Mehta N, Ahluwalia T, Blanchard J, Smith J, Douglass K. A qualitative study of workplace violence among healthcare providers in emergency departments in India. Int J Emerg Med 2020; 13:33. [PMID: 32552677 PMCID: PMC7301447 DOI: 10.1186/s12245-020-00290-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Emergency department (ED) workplace violence is increasingly recognized as an important issue for ED providers. Most studies have occurred in developed countries with established laws and repercussions for violence against healthcare providers. There is a paucity of data on workplace violence against ED providers in less developed countries. The aim of this study was to learn more about workplace violence among healthcare providers in EDs in India. Results Semi-structured interviews were conducted in-person with physicians, nurses, and paramedics in Indian EDs. Interviews were coded independently using the NVivo qualitative research software. A hybrid thematic analysis approach was used to determine dominant themes. Sixty-three interviews were conducted at 7 sites across India. Interview participants include attending physicians (11), resident physicians (36), nurses (10), and paramedics (5). Events were most often described as involving accompanying persons to the patient, not the patient themselves. Most events involved verbal abuse, although a significant percentage of responses described some kind of physical violence. ED factors such as busy times with high patient volumes or periods of waiting are associated with increased violence, as well as incidents with unanticipated outcomes such as patients with severe illness or death. Decreased levels of health literacy among patients often contribute as the financial stressors of paying for medical care. Providers reported negative consequences of workplace violence on quality of care for patients and their own motivation to work in the ED. Communication strategies were frequently proposed as interventions to mitigate violence in the future including both provider communication as well as public awareness campaigns. Conclusion Workplace violence is a frequent reality for this sample of Indian ED healthcare providers. Alarming levels of verbal and physical abuse and their impact on patient care are described. This qualitative study identified unique challenges to Indian ED providers that differ from those in more developed settings, including financial stressors, inadequate enforcement of rules governing behavior in the hospital, and an overwhelming frequency of violence emanating from patient family members and attendants rather than the patients themselves. Further investigation into preventive strategies is needed.
Collapse
Affiliation(s)
- Kevin Davey
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA.
| | - Veda Ravishankar
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| | - Nikita Mehta
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| | | | - Janice Blanchard
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| | - Jeffrey Smith
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| | - Katherine Douglass
- Department of Emergency Medicine, George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| |
Collapse
|
14
|
|
15
|
Recognition, prevention, and treatment of delirium in emergency department: An evidence-based narrative review. Am J Emerg Med 2020; 38:349-357. [DOI: 10.1016/j.ajem.2019.158454] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022] Open
|
16
|
Abstract
INTRODUCTION The emergency department of hospitals is known as a violent place, nevertheless the true incidence of violent acts in emergency departments in the German-speaking area has been little studied. The goal of this study was to record the occurrence of violence in a university hospital located in the inner city and to evaluate parameters, such as type of violence and accumulation in certain patient groups. MATERIAL AND METHODS Cases of violence in the emergency department were documented by the personnel over the time frame of 1 year (March 2017 to February 2018) and retrospectively evaluated. RESULTS An increase of violence during the evening hours (10.3% vs. 67.8%) could be shown. Intoxicated patients were responsible for the highest proportion of acts of violence. In addition, intoxicated patients were shown to be significantly more frequently aggressive than sober patients (63.72% vs. 31.65%). Non-intoxicated patients were as a rule only verbally aggressive. De-escalation by emergency room personnel was shown to be successful in 62.5% of the cases. In the rest of the cases help from outside, such as security personnel or the police was necessary, especially for intoxicated patients. DISCUSSION Violence occurs with high regularity in emergency departments. The average incidence of acts of violence of every 0.7 days shows the need for safety precautions for hospital personnel.
Collapse
|
17
|
Workplace violence by specialty among Peruvian medical residents. PLoS One 2018; 13:e0207769. [PMID: 30496220 PMCID: PMC6264828 DOI: 10.1371/journal.pone.0207769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of workplace violence among Peruvian medical residents and to evaluate the association between medical specialty and workplace violence per type of aggressor. METHODS This was a cross-sectional secondary analysis that used data from the Peruvian Medical Residents National Survey 2016 (ENMERE-2016). The outcome of interest was workplace violence, including physical and verbal violence, which were categorized according to the perpetrator of violence (patients/relatives and worker-to-worker). Primary exposure was the medical specialty, categorized as clinical, surgical, and other specialties. To evaluate the associations of interest, we estimated adjusted prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using Poisson regression models with robust variances. RESULTS A total of 1054 Peruvian medical residents were evaluated. The mean age was 32.6 years and 42.3% were female. Overall 73.4% reported having suffered of workplace violence sometime during the residency, 34.4% reported violence from patients/relatives, and 61.1% reported worker-to-worker violence. Compared with clinical residents, surgical residents had a lower prevalence of violence from patients/relatives (PR: 0.71; 95% CI: 0.59-0.87), but a higher prevalence of worker-to-worker violence (PR: 1.11, 95% CI: 1.01-1.23). CONCLUSION Nearly three quarters of medical residents reported having suffered workplace violence sometime during their residency. Compared with clinical residents, surgical residents had lower rates of violence from patients/relatives, but higher rates of worker-to-worker violence; while residents from non-clinical and non-surgical specialties had a lower prevalence of both types of violence.
Collapse
|
18
|
Gottlieb M, Long B, Koyfman A. Approach to the Agitated Emergency Department Patient. J Emerg Med 2018; 54:447-457. [PMID: 29395692 DOI: 10.1016/j.jemermed.2017.12.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute agitation is a common occurrence in the emergency department (ED) that requires rapid assessment and management. OBJECTIVE This review provides an evidence-based summary of the current ED evaluation and management of acute agitation. DISCUSSION Acute agitation is an increasingly common presentation to the ED and has a broad differential diagnosis including metabolic, neurologic, infectious, toxicologic, and psychiatric etiologies. Missed diagnosis of a dangerous etiology of the patient's agitation may result in severe morbidity and mortality. Assessment and management of the agitated patient should occur concurrently. Focused history and physical examination are recommended, though control of the patient's agitation may be required. All patients should receive a point-of-care glucose test, with additional testing depending upon the specific patient presentation. Initial management should involve verbal de-escalation techniques, followed by pharmacologic interventions, with physical restraints reserved as a last resort. Pharmacologic options include first-generation antipsychotics, second-generation antipsychotics, benzodiazepines, and ketamine. Finally, the management of pediatric, pregnant, and elderly patients warrants special consideration. CONCLUSION Acute agitation is an important presentation that requires prompt recognition and treatment. A focused and thorough examination coupled with appropriate management strategies can assist emergency clinicians to safely and effectively manage these patients.
Collapse
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
19
|
Abstract
Objectives To study the nature, frequency and magnitude of violence in a local emergency department. Design Prospective epidemiological study in a three-month period, during which involved staff filled in a survey form immediately after violence incidents. Setting Accident & Emergency Department of a public general hospital in the northeastern New Territories. Population Assailants and victims of violence in the emergency department. Main outcome measures Nature of violence, frequency, cause, morbidity, epidemiological characteristics of assailants and victims. Results There were 25 incidents with 26 assailants in the three-month period. The great majority was verbal abuse only (64%). No weapon was involved. Long waiting time (36%), deranged mental condition (28%) and dissatisfaction with service (20%) were the leading causes of violence. Assailants showed a predominance of male (69%) and age between 21–50 years. They were either patients (69%) or accompanying persons (31%). Nurses (59%) and to a lesser extent doctors (23%), were the main victims. Conclusion The incidence of emergency department violence (0.08%) was low and the majority was verbal abuse only. Nurses bore the brunt of the violence. Long waiting time, confused patients and dissatisfied patients were high risk factors.
Collapse
|
20
|
Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana. Emerg Med Int 2016; 2016:6082105. [PMID: 27885343 PMCID: PMC5112300 DOI: 10.1155/2016/6082105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Abstract
Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care.
Collapse
|
21
|
Yassi A, Tate R, Cooper J, Jenkins J, Trottier J. Causes of Staff Abuse in Health Care Facilities. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/216507999804601007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Verbal and physical abuse of health care workers (HCWs) is prevalent and costly. A 3 month prospective study was conducted to characterize precipitating conditions and the perpetrators of abusive incidents reported by HCWs at a large inner city hospital. Sixty-six HCWs reporting 102 incidents were interviewed by a research nurse within 48 hours of the incident. Abusive incidents resulted from 55 different patients and 11 visitors. Verbal abuse accounted for 42 incidents (41%) and 60 (59%) involved physical abuse. Two thirds of the abuse occurred on psychiatric wards, 20% on inpatient wards, and 13% in other settings. Overall, twice as many abusive incidents were inflicted by males as females. Cognitive impairment accounted for 19% of the incidents and one abuser was intoxicated at the time. Rule enforcement precipitated abuse in 70% of incidents. Researchers concluded that reviewing rules that apply to patients, how HCWs are trained to enforce rules, how to respond when service requested cannot be provided promptly, and how HCWs can protect themselves when performing a service were important elements in the prevention of staff abuse.
Collapse
|
22
|
|
23
|
Korczak V, Kirby A, Gunja N. Chemical agents for the sedation of agitated patients in the ED: a systematic review. Am J Emerg Med 2016; 34:2426-2431. [PMID: 27707527 DOI: 10.1016/j.ajem.2016.09.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/04/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events. METHODS Systematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database. Meta-analyses for pairwise comparisons of drug class (benzodiazepine, antipsychotic, or combination) were carried out for each outcome: proportion sedated, need for repeat sedation, and adverse events. RESULTS Seven studies with 1135 patients were included. At 15-20 minutes, the proportion of patients sedated was greater with combination therapy than benzodiazepines alone (risk ratio [RR] = 1.31, P < .0001). Antipsychotics and combination agents required significantly less repeat sedations than benzodiazepines alone (RR = 0.49, P < .0001 and RR = 0.64, P = .002). There was significant heterogeneity in adverse event data, with respiratory system adverse events (desaturation, and need for airway and ventilatory support) being the most commonly reported. Benzodiazepines were associated with a higher incidence of adverse events than antipsychotics or combination therapy. CONCLUSION Combination therapy sedated a greater proportion of patients at 15-20 minutes than benzodiazepines alone. Antipsychotics and combination therapy were more effective, requiring less repeat doses for sedation than benzodiazepines. The risk of any adverse event was higher with benzodiazepines.
Collapse
Affiliation(s)
| | | | - Naren Gunja
- Westmead Hospital, Sydney, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, New South Wales, Australia.
| |
Collapse
|
24
|
Schoenfisch AL, Pompeii LA. Security Personnel Practices and Policies in U.S. Hospitals. Workplace Health Saf 2016; 64:531-542. [DOI: 10.1177/2165079916653971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concerns of violence in hospitals warrant examination of current hospital security practices. Cross-sectional survey data were collected from members of a health care security and safety association to examine the type of personnel serving as security in hospitals, their policies and practices related to training and weapon/restraint tool carrying/use, and the broader context in which security personnel work to maintain staff and patient safety, with an emphasis on workplace violence prevention and mitigation. Data pertaining to 340 hospitals suggest security personnel were typically non-sworn officers directly employed (72%) by hospitals. Available tools included handcuffs (96%), batons (56%), oleoresin capsicum products (e.g., pepper spray; 52%), hand guns (52%), conducted electrical weapons (e.g., TASERs®; 47%), and K9 units (12%). Current workplace violence prevention policy components, as well as recommendations to improve hospital security practices, aligned with Occupational Safety and Health Administration guidelines. Comprehensive efforts to address the safety and effectiveness of hospital security personnel should consider security personnel’s relationships with other hospital work groups and hospitals’ focus on patients’ safety and satisfaction.
Collapse
|
25
|
Pati D, Pati S, Harvey TE. Security Implications of Physical Design Attributes in the Emergency Department. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 9:50-63. [PMID: 26794235 DOI: 10.1177/1937586715626549] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel. OBJECTIVE The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations. METHOD An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states. RESULTS Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations. CONCLUSION Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.
Collapse
Affiliation(s)
- Debajyoti Pati
- Department of Design, Texas Tech University, Lubbock, TX, USA
| | - Sipra Pati
- Center for Advanced Design Research & Evaluation (CADRE), Dallas, TX, USA
| | | |
Collapse
|
26
|
Docimo S, Diggs L, Crankshaw L, Lee Y, Vinces F. No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients. Indian J Surg 2015; 77:265-9. [PMID: 26702232 DOI: 10.1007/s12262-015-1283-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Digital rectal exams (DRE) are routinely used on trauma patients during the secondary survey as recommended by current Advanced Trauma Life Support (ATLS) protocols. However, recent literature has called the blanket use of the DRE on each trauma patient into question. The purpose of this study was to evaluate the efficacy of the DRE as a diagnostic tool in the setting of urethral, spinal cord, small bowel, colon, and rectal injuries and determine if it can be eliminated from routine use in the trauma setting. Trauma patients with small bowel, colon, rectal, urethral, and spinal cord injuries, age of 18 years or older, and a noted DRE were included. Exclusion criteria included an age less than 18, patients who received paralytics, a Glasgow Coma Scale (GCS) of 3, and a history of paraplegia or quadriplegia. One-hundred eleven patient records were retrospectively reviewed. Ninety-two male (82.9 %) and 19 (17.1 %) females with a GCS of 13.7 were evaluated. Sixty-two (55.9 %) injuries were penetrating with 49 (44.1) being blunt. The DRE missed 100 % of urethral, 91.7 % of spinal cord, 93.1 % of small bowel, 100 % of colon, and 66.7 % of rectal injuries. For injuries confirmed with radiologic modalities, the DRE missed 93.3 %. For injuries confirmed on exploratory laparotomy, the DRE missed 94.9 %. The DRE has poor sensitivity for the diagnosis of urethral, spinal cord, small bowel, and large bowel injury. The DRE was found to be the most sensitive in the setting of rectal injuries. The DRE offers no benefit or predictive value when compared to other imaging modalities.
Collapse
Affiliation(s)
- Salvatore Docimo
- Department of Surgery, NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220 USA
| | - Laurence Diggs
- NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220 USA
| | - Laura Crankshaw
- NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220 USA
| | - Young Lee
- NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220 USA
| | - Fausto Vinces
- Department of Surgery, St. Barnabas Hospital, 4422 Third Avenue, Bronx, NY 10457 USA
| |
Collapse
|
27
|
Hostiuc S, Dermengiu D, Hostiuc M. Violence against physicians in training. A Romanian perspective. J Forensic Leg Med 2014; 27:55-61. [PMID: 25287801 DOI: 10.1016/j.jflm.2014.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022]
Abstract
The main purpose of this study was to assess whether there are differences between perceived and actual aggressions directed towards medical trainees from different medical specialties and different stages of medical training, and to characterize various types of aggressions against physicians in training in Romania. A multi-institutional survey was conducted in order to assess the prevalence of perceived and actual violence during medical residents; it included a total number of 384 medical residents from various specialties. Thirty two cases declared perceived physical aggression, most often in psychiatry. Actual physical aggression was 48% higher compared to perceived physical aggression. A similar situation occurred for sexual harassment, with only 9 perceived and 65 actual cases (an increase of 722%). Psychological abuse was the easiest to identify by the physicians in training, as the difference between perceived and actual aggression was minimal (202 and 205 respectively). The degree of perceived violence against physicians in training was much lower than the actual prevalence of the phenomenon, especially for physical and sexual types. This decreased awareness may lead to a failure in taking necessary safety measures and may subsequently increase the severity and consequences of the violent acts directed towards them.
Collapse
Affiliation(s)
- Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy, Dept. of Legal Medicine and Bioethics, National Institute of Legal Medicine, Bucharest, Romania.
| | - Dan Dermengiu
- Carol Davila University of Medicine and Pharmacy, Dept. of Legal Medicine and Bioethics, National Institute of Legal Medicine, Bucharest, Romania
| | - Mihaela Hostiuc
- Carol Davila University of Medicine and Pharmacy, Dept. of Internal Medicine, Floreasca Clinical Emergency Hospital, Bucharest, Romania
| |
Collapse
|
28
|
Vezyridis P, Samoutis A, Mavrikiou PM. Workplace violence against clinicians in Cypriot emergency departments: a national questionnaire survey. J Clin Nurs 2014; 24:1210-22. [DOI: 10.1111/jocn.12660] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alexis Samoutis
- School of Health Sciences; Frederick University Cyprus; Nicosia Cyprus
| | - Petroula M Mavrikiou
- School of Economic Sciences and Administration; Frederick University Cyprus; Nicosia Cyprus
| |
Collapse
|
29
|
McClelland H. What can we do about Violence? Int Emerg Nurs 2014. [DOI: 10.1016/j.ienj.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial. BMC Health Serv Res 2014; 14:221. [PMID: 24885544 PMCID: PMC4055169 DOI: 10.1186/1472-6963-14-221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital. Methods/Design This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded. Discussion The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof. The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).
Collapse
|
31
|
Abstract
Acutely agitated and combative patients are commonly seen and evaluated by health care providers in the emergency department. Treatment options have evolved significantly in recent years with the advent of intramuscular atypical antipsychotics and an expanded repertoire of patient-friendly oral formulations. Selection of the ideal pharmacologic treatment of an acutely agitated patient strengthens the patient-prescriber relationship and promotes adherence to future therapy. In this article, advantages and disadvantages of various treatment modalities for undifferentiated, psychotic, and nonpsychotic agitation are reviewed, including alternatives to the commonly prescribed haloperidol and lorazepam combination. Atypical antipsychotics may be superior in certain patients, with the added benefit of easier conversion to maintenance therapy. Special consideration is given to the treatment of acutely agitated geriatric patients suffering from delirium and/or dementia. Management of these patients should be guided by etiology and patient characteristics to obtain maximum therapeutic benefit. Although emergency department providers may only see a given patient once, the health care team must have an evidence-based approach to the care that is provided in the emergency department, as it can significantly influence the patient's overall course of treatment in the outpatient setting.
Collapse
|
32
|
An Association Between Occupancy Rates in the Emergency Department and Rates of Violence Toward Staff. J Emerg Med 2012; 43:736-44. [DOI: 10.1016/j.jemermed.2011.06.131] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 04/04/2011] [Accepted: 06/05/2011] [Indexed: 11/20/2022]
|
33
|
Zun LS, Downey LVA. Level of agitation of psychiatric patients presenting to an emergency department. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:108-13. [PMID: 18458724 DOI: 10.4088/pcc.v10n0204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 10/18/2007] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained. METHOD An observational study enrolling a convenience sample of 100 patients presenting with a psychiatric complaint was planned, in order to obtain 50 chemically and/or physically restrained and 50 unrestrained patients. The study was performed in summer 2004 in a community, inner-city, level 1 emergency department with 45,000 visits per year. The level of patient agitation was measured using the Agitated Behavior Scale (ABS) and the Richmond Agitation-Sedation Scale (RASS) upon arrival and every 30 minutes over a 3-hour period. The inclusion criteria allowed entry of any patient who presented to the emergency department with a psychiatric complaint thought to be unrelated to physical illness. Patients who were restrained for nonbehavioral reasons or were medically unstable were excluded. RESULTS 101 patients were enrolled in the study. Of that total, 53 patients were not restrained, 47 patients were restrained, and 1 had incomplete data. There were no differences in gender, race, or age between the 2 groups. Upon arrival, 2 of the 47 restrained patients were rated severely agitated on the ABS, and 13 of 47 restrained patients were rated combative on the RASS. There was a statistical difference (p = .01) between the groups on both scales from time 0 to time 90 minutes. Scores on the agitation scales decreased over time in both groups. One patient in the unrestrained group became unarousable during treatment. CONCLUSION This study demonstrated that patients who were restrained were more agitated than those who were not, and that agitation levels in both groups decreased over time. Some restrained patients did not meet combativeness or severe agitation criteria, suggesting either that use of other criteria is needed or that restraints were used inappropriately. Further study of the level of agitation and the effects of restraints is needed.
Collapse
Affiliation(s)
- Leslie S Zun
- Department of Emergency Medicine, Rosalind Franklin University of Medicine and Science/Chicago Medical School, and the Department of Emergency Medicine, Mount Sinai Hospital, Chicago, IL, USA.
| | | |
Collapse
|
34
|
Marco CA, Kowalenko T. Competence and challenges of emergency medicine training as reported by emergency medicine residents. J Emerg Med 2012; 43:1103-9. [PMID: 22883717 DOI: 10.1016/j.jemermed.2012.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/21/2012] [Accepted: 05/20/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Board of Emergency Medicine conducts an annual survey of residents in Emergency Medicine, the Longitudinal Study of Residents in Emergency Medicine survey. OBJECTIVE This study was undertaken to describe self-reported competence and challenges facing Emergency Medicine (EM) residents. METHODS In this descriptive, observational analysis of the Longitudinal Study of Residents in Emergency Medicine survey, survey data from 1996-2008 were compared for 70 survey items. Responses were analyzed with means and 95% confidence intervals by post-graduate year (PGY) and over time. RESULTS A total of 496 residents were included in this study. Most participated for 3 years, for a total of 1320 total responses. The most serious day-to-day challenges reported by residents (overall median scores of 3 or more) included knowing enough, keeping up with the medical literature, having enough time for personal life, ancillary support, and having enough time for family. Current level of competence in areas deemed weakest by residents included grant writing, contract negotiation, academic writing, disaster planning, research, and financial management. Residents reported improved competence in most (15 out of 16) areas from PGY-1 to PGY-3 year of training. Resident reports of competence did not change significantly over time from 1998-2008 (15 out of 16 items). CONCLUSIONS Emergency Medicine residents identified several important day-to-day problems, including knowing enough, keeping up with the medical literature, and having enough time for a personal life. PGY-3 residents reported improved competence in almost all aspects of EM work and clinical EM as compared to PGY-1 residents. Knowledge of perceived competence and problems among EM residents is crucial to the development of improved educational approaches to address these issues.
Collapse
Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, University of Toledo College of Medicine, Toledo, Ohio 43614, USA
| | | |
Collapse
|
35
|
Ho JD, Clinton JE, Lappe MA, Heegaard WG, Williams MF, Miner JR. Introduction of the Conducted Electrical Weapon into a Hospital Setting. J Emerg Med 2011; 41:317-23. [DOI: 10.1016/j.jemermed.2009.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/14/2009] [Accepted: 09/28/2009] [Indexed: 11/24/2022]
|
36
|
Kling RN, Yassi A, Smailes E, Lovato CY, Koehoorn M. Evaluation of a violence risk assessment system (the Alert System) for reducing violence in an acute hospital: A before and after study. Int J Nurs Stud 2011; 48:534-9. [DOI: 10.1016/j.ijnurstu.2010.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 09/04/2010] [Accepted: 10/22/2010] [Indexed: 11/27/2022]
|
37
|
Belayachi J, Berrechid K, Amlaiky F, Zekraoui A, Abouqal R. Violence toward physicians in emergency departments of Morocco: prevalence, predictive factors, and psychological impact. J Occup Med Toxicol 2010; 5:27. [PMID: 20920159 PMCID: PMC2954930 DOI: 10.1186/1745-6673-5-27] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 09/28/2010] [Indexed: 11/23/2022] Open
Abstract
Introduction Anyone working in the hospital may become a victim of violence. The effects of violence can range in intensity and include the following: minor physical injuries, serious physical injuries, temporary or permanent physical disability, psychological trauma, and death. The aim of this study was to determine the frequency of exposure, characteristics, and psychological impact of violence toward hospital-based emergency physicians in Morocco. Methods This was a survey including emergency physicians who ensured emergency service during the last fortnight. The variables studied were those related to the victim (age and gender), and those related to aggression: assaulter gender, number, time, reason (delay of consultation and/or care, acute drunkenness, neuropsychiatric disease), and type (verbal abuse, verbal threat and/or physical assault). After the questionnaire was completed, State-Trait Anxiety Inventory (STAI) of Spielberg was applied to all participants. Results A total of 60 physicians have achieved permanence in emergency department during the 15 days preceding the questionnaire response. The mean age was 24 ± 1 year and 57% were male. A total of 42 (70%) had been exposed to violence. The violence occurred at night n = 16 (27%), afternoon n = 13 (22%), evening n = 7 (12%) and morning n = 6 (10%). Reasons for violence were: the delay of consultation or care in n = 31 (52%) cases, acute drunkenness in n = 10 (17%) cases and neuropsychiatric disease in n = 3 (5%) cases. Twenty eight (47%) participants stated that they experienced verbal abuse, n = 18 (30%) verbal threat and n = 5 (8.3%) physical assault. Exposure to some form of violence was related to a higher median [interquartile range, IQR] state anxiety point (SAP); (51 [46-59] vs 39 [34-46]; P < 0,001), and trait anxiety point (TAP) (48 [41-55] vs 40,5 [38-53]; P = 0,01). Conclusions This study revealed a high prevalence (70%) of violence toward doctors in Morocco emergency departments. The exposure of physicians to some form of violence is greater among doctors with anxiety trait and was related to significant degree of anxiety state.
Collapse
Affiliation(s)
- Jihane Belayachi
- Medical Emergency Department, Ibn Sina University Hospital, 10000, Rabat, Morocco.
| | | | | | | | | |
Collapse
|
38
|
What Variables Are Associated With an Expressed Wish to Kill a Doctor in Community and Injured Patient Samples? J Clin Psychol Med Settings 2010; 17:87-97. [DOI: 10.1007/s10880-010-9190-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
39
|
Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 2010; 40:565-79. [PMID: 20133103 DOI: 10.1016/j.jemermed.2009.11.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 11/03/2009] [Accepted: 11/10/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Violence in the Emergency Department (ED) is a well-known phenomenon. Few studies have been done to assess the incidence and nature of violence in the ED. STUDY OBJECTIVES The purpose of this study was to assess the incidence of violence in the ED nationwide. METHODS This study was a prospective, cross-sectional online survey of Emergency Medicine (EM) residents and attending physicians. Of the 134 accredited United States (US) EM residency programs, 65 programs were randomly selected and invited to participate. RESULTS Overall, 272 surveys were returned, of which 263 (97%) were completed and further analyzed. At least one workplace violence act in the previous 12 months was reported by 78% (95% confidence interval 73-83%) of respondents, with 21% reporting more than one type of violent act. Workplace violence was experienced similarly between males and females (79% vs. 75%, respectively; p = 0.65), and was more common in EDs with annual volumes over 60,000 patients (82% vs. 67%; p = 0.01). The most common type of workplace violence was verbal threats (75%) followed by physical assaults (21%), confrontations outside the workplace (5%), and stalking (2%). Security was available full time in most settings (98%), but was least likely to be physically present in patient care areas. The majority of respondent EDs did not screen for weapons (40% screened) or have metal detectors (38% had metal detectors). Only 16% of programs provided violence workshops, and less than 10% offered self-defense training. CONCLUSION Despite the high incidence of workplace violence experienced by the emergency physicians who responded to our survey, less than half of these respondents worked in EDs that screened for weapons or had metal detectors. An even smaller number of physicians worked in settings that provided violence workshops or self-defense training.
Collapse
|
40
|
|
41
|
|
42
|
Brookes JG, Dunn RJ. The incidence, severity and nature of violent incidents in the emergency department. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1442-2026.1997.tb00548.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Fishbain DA, Bruns D, Disorbio JM, Lewis JE. Correlates of Self-Reported Violent Ideation Against Physicians in Acute- and Chronic-Pain Patients. PAIN MEDICINE 2009; 10:573-85. [DOI: 10.1111/j.1526-4637.2009.00606.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Griffey RT, Wittels K, Gilboy N, McAfee AT. Use of a Computerized Forcing Function Improves Performance in Ordering Restraints. Ann Emerg Med 2009; 53:469-76. [DOI: 10.1016/j.annemergmed.2008.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 05/08/2008] [Accepted: 05/15/2008] [Indexed: 11/30/2022]
|
45
|
Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, Camargo CA, Blumenthal D. A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med 2008; 15:1268-74. [PMID: 18976337 DOI: 10.1111/j.1553-2712.2008.00282.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety. METHODS Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety. RESULTS A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One-fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5-year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe "most of the time" or "always" when compared to other surveyed staff. CONCLUSIONS This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff.
Collapse
Affiliation(s)
- Susan M Kansagra
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Children's mental health emergencies-part 3: special situations: child maltreatment, violence, and response to disasters. Pediatr Emerg Care 2008; 24:569-77. [PMID: 18708906 DOI: 10.1097/pec.0b013e318180fef2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children may be exposed to or even be the victims of a violent situation, or a disaster, and the likelihood of a child's exposure to a violent situation or a disaster is increasing. METHODS A review of the literature was done to address key mental health issues occurring with child maltreatment, violence in the home, community, in the emergency department, and disasters. RESULTS Although pediatric mental health issues regarding violence, disasters, and child maltreatment have often been overlooked or unrecognized, the consequences for the child in such situations can be devastating. However, recognition and appropriate treatment can favorably impact the child's recovery from exposure to such violent events or disasters. CONCLUSIONS Recognition and early intervention to address the mental health issues of children in violent situations or disasters can help ameliorate the negative psychological sequelae of such events. The importance of providing mental health and social services to children exposed to disasters was recognized by the Pediatric Institute of Medicine Report.
Collapse
|
47
|
Ferns T. Considering theories of aggression in an emergency department context. ACTA ACUST UNITED AC 2007; 15:193-200. [PMID: 17919912 DOI: 10.1016/j.aaen.2007.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 06/21/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
Abstract
Internationally literature emphasises concern regarding the phenomenon of violence and aggression within the emergency field. This paper emphasises the important role education and training may play in reducing the risk of staff being exposed to violent or aggressive experiences. Furthermore, the paper emphasises, explores and discusses well recognised theories relating to aggression development. These theories can be used to explain both organisational strategies designed to minimise aggression in the emergency department and situational factors contributing to the development of aggressive interactions.
Collapse
Affiliation(s)
- Terry Ferns
- University of Greenwich, School of Health and Social Care, Department of Acute and Continuing Care, Grey Building, Southwood Site, London SE9 2UG, UK.
| |
Collapse
|
48
|
Sellaturay S, Arya M, Makepeace J, Sellaturay P, Henry JA. Management of alcohol intoxication and aggressive behaviour: a tale of two cities. Curr Med Res Opin 2007; 23:77-83. [PMID: 17257468 DOI: 10.1185/030079906x159470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Violence and aggressive behaviour are a growing problem in emergency departments on both sides of the Atlantic, and alcohol intoxication is often involved. A wide range of management options is available, and policies vary considerably. METHODS We compared the management of alcohol intoxication and aggressive behaviour in four New York and four London emergency departments, using a semi-structured interview which covered 15 issues. RESULTS Differences were apparent between New York and London emergency departments in the method used for diagnosis of alcohol intoxication, the investigations carried out and discharge criteria. Chemical and physical restraints were readily and frequently used in New York in order to prevent intoxicated patients leaving the department, while in London disruptive patients tended to be ejected. CONCLUSIONS The marked transatlantic differences, while partly due to cultural and historic reasons, are largely due to the pressures to limit the risk of litigation in the United States and the constraints of a cost-limited health service in Britain. The management of violent and intoxicated patients deserves further refinement.
Collapse
|
49
|
Cioffi J, Salter C, Wilkes L, Vonu-Boriceanu O, Scott J. Clinicians' responses to abnormal vital signs in an emergency department. Aust Crit Care 2006; 19:66-72. [PMID: 16764154 DOI: 10.1016/s1036-7314(06)80011-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The importance of observing patient vital signs in emergency department (ED) practice has been stressed in the literature. Failure of clinicians to respond to abnormal vital signs (AVS) has been described as a potential reason for delayed management in ED practice, with a likelihood of increased morbidity. This study aimed to explore and describe clinicians' responses to AVS in a busy ED. A qualitative descriptive approach was used with three focus groups being conducted with 18 volunteer registered nurses (RNs) and medical officers (MOs) who worked in the ED of an area health service in Western Sydney. Transcribed focus group interviews were analysed using a process of constant comparison and contrast and a description of clinicians' responses to AVS written. An analysis of text from focus groups revealed three main categories of clinicians' responses to AVS: identification, reporting and implementing action. Clinicians in this study recognised, reported and acted on AVS. However, delays in responding to AVS occurred due to a variety of reasons. The main reasons identified were issues with documentation and the ability to seek advice of appropriate staff, ineffective communication, fear of reprimand, inexperience of working in EDs, workload, distractions and interruptions. In conclusion, environmental and human factors contribute to inappropriate delays regarding AVS in the ED. These factors can be acted on by initiating appropriate education programmes and establishing improved communication networks. Better use of the existing medical emergency team (MET) in the ED can act to alleviate situations associated with delays in managing AVS.
Collapse
|
50
|
Lau JB, Magarey J. Review of research methods used to investigate violence in the emergency department. ACTA ACUST UNITED AC 2006; 14:111-6. [PMID: 16564170 DOI: 10.1016/j.aaen.2006.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 02/01/2006] [Indexed: 10/24/2022]
Abstract
Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.
Collapse
Affiliation(s)
- Jacqui Bc Lau
- Eleanor Harrald Building, Department of Clinical Nursing, The University of Adelaide, Australia.
| | | |
Collapse
|