Violence in the emergency department is a frightening reality in medicine today. Alongside the critical care services they perform, emergency medicine providers often face verbal abuse, physical assault, confrontations and other forms of aggression. In a January 2024 poll by the American College of Emergency Physicians, 91% of emergency physicians report that they, or a colleague, were a victim of violence in the past year.
As healthcare professionals dedicated to ensuring the well-being of all individuals, it’s essential for emergency medicine providers to implement best practices to prevent violence and create safer environments for staff and patients. Here are six important best practices to minimize/eliminate emergency department violence:
- Staff Training and Education: Comprehensive training programs are essential for equipping emergency medicine (and other) healthcare providers with the skills and knowledge to handle challenging situations safely. Key topics to cover include regular training sessions on de-escalation and other means of violence prevention, crisis intervention and self-defense techniques. Read specific de-escalation steps and techniques in this article from Relias Media.
- Security Measures: The implementation of robust security measures is tantamount to deterring violence and protecting both patients and staff. The American College of Emergency Physicians recommends a number of items including 24-7 trained security personnel in the emergency department, surveillance cameras, metal detectors and separated patient and staff working areas. Collaboration with local law enforcement agencies is crucial to developing emergency response protocols and coordinating rapid assistance in critical situations as well.
- Environmental Design: Thoughtful design and layout of the emergency department can contribute significantly to its safety and security. Ensure that waiting areas are well-lit, easily monitored, and free of potential hazards. Create designated safe spaces for de-escalation and provide clear signage to guide patients and visitors. Consider implementing security checkpoints or triage processes to identify and address potential risks early.
- Patient Screening and Risk Assessment: Standardized screening protocols are required to identify patients with a history of violent behavior or substance abuse issues. Conduct thorough risk assessments upon admission to identify individuals who may pose a risk to themselves or others. The Journal of Emergency Nursing highlights the Broset Violence Checklist as an effective assessment tool.
- Post-Incident Support and Debriefing: Comprehensive support services for emergency medicine staff members involved in violent incidents is crucial. The Annals of Emergency Medicine study Protection from Violence in the Emergency Department highlights the importance of offering medical treatment, counseling, debriefing sessions and employee assistance for affected providers and staff. As part of the debriefing process, open dialogue and feedback is necessary to identify areas for improvement and implement corrective measures.
- Collaborative Care Approach: Foster a culture of collaboration and teamwork among healthcare providers, including physicians, nurses, other staff and security personnel. In partnership with mental health professionals and social workers, emergency departments can develop personalized care plans for high-risk patients and provide appropriate support and supervision. Encourage open communication and information sharing to ensure that all members of the care team are informed and prepared to respond effectively to potential threats.
Recap
The imperative to enhance safety in emergency departments demands a multifaceted approach that prioritizes proactive measures and collaborative efforts. By adopting these and other best practices, emergency medicine providers can take proactive steps to prevent violence and enhance safety within their departments – and continue to deliver excellence in emergency care.
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