Reducing Violence Relating To Long Stays In The Emergency Department

 Long Waits In The Emergency Department Exacerbate Agitation,
Especially For Behavioral Health Patients.

The healthcare workforce shortage that existed before the COVID-19 pandemic is now a full-blown crisis. In 2022 alone, 500,000 nurses were expected to leave the workforce, creating a shortage of more than 1.1 million nurses.

The increasing threat and incidence of workplace violence is contributing to the ongoing exodus of healthcare workers. Violence against U.S. healthcare workers has been on the rise for at least a decade and has accelerated during the COVID-19 pandemic, particularly in hospital emergency departments, where the combination of a large patient volume and high-stakes, emotionally difficult situations, staff shortages, and at-risk patients creates tension and frustration that can escalate quickly to physical and verbal threats and violence. The rate of serious workplace violence incidents is four times greater in the healthcare field than is the case in private industry.

As we all know, for hospital security teams responsible for keeping patients, visitors, and employees safe, managing security in the emergency department is paramount. Staff are much more likely to be injured in EDs than any other area in the hospital [3]. Since January 1, 2022, hospitals have had an added incentive to focus on protecting healthcare workers: the new and revised Joint Commission standards for workplace violence prevention for all accredited hospitals and critical access hospitals.

One way to reduce the risk of workplace violence in the ED is to improve ED “throughput,” ensuring that patients are admitted or transferred to another facility without unnecessary delay. Improving throughput can help by lessening patient anxiety and potentially preventing decompensation by patients who are experiencing a serious psychiatric condition. Improving ED throughput is not a substitute for a holistic, multidisciplinary strategy to reduce and address workplace violence and create a clinical de-escalation management model, but it should be one of the elements in that strategy.

Unfortunately, too many hospital emergency departments still rely on antiquated, manual processes to manage patient transfers. In their search for a bed for their ED patients, clinicians still are calling other hospitals one-by-one, leaving messages, faxing paperwork, and waiting for calls to be returned. The seemingly simple act of transferring a patient out of the ED to another facility is requiring clinicians to spend countless hours on repetitive tasks that take them away from direct patient care at the bedside and contribute to lengthy delays in getting to therapeutic care. In this article, I review data relating to violence in the ED, outline some good practices for reducing that violence, and describe a technology that can address the slow throughput problem.

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(Shana Palmieri, LCSW, is the Managing Partner of Clinical Education & Consulting at Healthcare Legal Education and Consulting Network in Honolulu, HI, and COO and Co- Founder of XFERALL, based in Austin, TX.)

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