Most emergency physicians say violence is rising

Nearly all emergency physicians are seeing an increase in violence, and they say it’s taking a toll on doctors, nurses and patient care.

The violence is significantly higher over the last four years, particularly since the emergence of the COVID-19 pandemic, according to a new poll released Thursday by the American College of Emergency Physicians.

Emergency department staff are experiencing more attacks and it’s adding to the stress on doctors and nurses at a time when most health systems are already seeing labor shortages. Alex Skog, president-elect of the Oregon Chapter of the American College of Emergency Physicians, said in a media call Thursday there was an incident at his facility just within recent days.

“Now more than ever, we feel it’s gotten to a level that’s completely unsustainable,” Skog said.

Emergency physicians say they’re increasingly being physically assaulted and receiving credible threats of violence from patients or their family members, said Chris Kang, president-elect of the American College of Emergency Physicians.

The organization polled 2,712 of its members between July 25 and August 1. The survey found sharp increases since a similar poll was conducted in 2018.

Here are some of the key findings:

• The poll found 45% said violence in the emergency department has greatly increased in the past five years, compared to 25% in a 2018 survey. Overall, 85% of respondents said there has been at least some increase in violence.
• Over half (55%) said they were physically assaulted, up from 47% in 2018. Nearly 8 in 10 (79%) said they witnessed an assault.
• Nearly a quarter (24%) or respondents said they have had multiple assaults in a week, while 40% said they are assaulted once a month.
• Nearly 9 in 10 (89%) of those surveyed said emergency department violence is hurting patient care.

Despite the rise in assaults, hospitals are rarely trying to have attackers prosecuted, the poll indicated. Only 2% of respondents said hospital security pressed charges, and that’s adding to the danger for emergency department staff, Kang said.

“Hospital law enforcement support is inconsistent,” Kang said.

“The lack of consequences … is believed to be a significant contributor to the rise of violence since 2018.”

Emergency physicians say they need more support.

“The biggest thing we are asking for is hospitals and legislative bodies to see what they can do to quantify incidents and provide better guardrails against violence,” Skog said.

• Read more: ‘Patients deserve better’: Hospital leaders describe cuts in services due to financial woes

‘It’s heartbreaking’

Some attacks have gained media attention.

This week, a nurse was stabbed at a hospital in Los Angeles, the Associated Press reports. Four people were shot and killed on the campus of an Oklahoma medical center, as authorities said the gunman blamed a surgeon for pain following an operation.

But many attacks never generate headlines, doctors say. Some incidents likely aren’t being reported, Kang said.

Earlier in his career, Skog said violence in the emergency department was relatively rare. That’s no longer the case, noting his emergency department in Portland, Ore. has had two incidents in the past few weeks, Skog said.

“It’s heartbreaking to me,” Skog said. “That’s something we were not seeing three, four years ago.”

“Providers are talking about this more, but that’s only because the incidents have simply exploded,” he said.

Within the last several days, Skog said a patient attacked staff in his emergency department, tackling a technician and cutting a doctor’s forearm. It took a host of staff members to subdue the patient.

“When this happened, the whole emergency department was essentially paralyzed,” Skog said.

The hospital had to divert all ambulances to other hospitals for several hours. It also delayed treatment for patients already in the emergency department, Skog said.

Emergency physicians said violent incidents are exacerbating the long waits patients are experiencing, a subject that’s also gaining growing attention. Most of those surveyed (85%) said violence is increasing wait times. And 87% reported a loss of productivity.

‘Emotional trauma’

The delays for patients caused by violent episodes are adding to the stress of emergency staff, Kang said.

“That has a profound impact on the sense of duty many emergency departments have,” he said, adding, “There’s a sense of emotional trauma that we can't do the job we believe we should be doing.”

“It’s our mental health, it’s our wellbeing when we can’t do our jobs,” he said.

While it’s difficult to get a number on how many doctors and nurses are leaving jobs due to the spike in violence, emergency physicians said it’s clearly playing a role in getting some staff to make career changes.

“Emergency medicine is hemorrhaging nurses, technicians and doctors,” Skog said.

After the recent attack in his emergency department, he overheard one nurse say, “I'm telling my supervisor I’m never coming down here again. This is not safe.”

Violence in healthcare has been gaining more attention in recent months. About half of hospital nurses (48%) reported an increase in workplace violence, according to a survey released in the spring by National Nurses United. Nursing leaders have said the violence, along with burnout, is driving some nurses to leave hospitals.

Brine Hamilton, president of the International Association for Healthcare Security and Safety, told Chief Healthcare Executive in June that workplace violence has risen since the arrival of COVID-19.

“It seems to be a problem that has only gotten worse in the pandemic,” Hamilton said.

Even before the pandemic, violence in healthcare was a significant problem. Healthcare workers accounted for nearly 3 out of 4 injuries (73%) sustained in workplace violence, according to a 2018 U.S. Labor Department study. But healthcare leaders say the violence in hospitals has worsened in the pandemic.

Some hospitals are turning to metal detectors to screen for weapons, and armed security and police.

Those measures have benefits in some cases, but they may not be appropriate for every hospital and could add to tension in communities, Skog said. Such solutions should be employed on a case-by-case basis.

However, emergency physicians would like hospitals and health systems to be more aggressive in pursuing charges when staff are assaulted. They also should conduct rigorous examinations of their operations and see where security should be improved, Kang said.

Legislative remedies

The emergency physicians’ group pointed to legislation in Congress that could bolster protections for healthcare workers.

U.S. Reps. Madeleine Dean, a Pennsylvania Democrat and Larry Bucshon, an Indiana Republican, introduced the bipartisan Safety From Violence for Healthcare Employees (SAVE) Act in June. Bucshon is a medical doctor. The legislation would impose tougher penalties on those who attack and intimidate health system employees.

Lawmakers note that there’s no federal law granting specific protections for healthcare workers. The bill is modeled after similar protections for airline and airport employees.

The American Hospital Association, which has endorsed the House bill, has been pushing for greater protections for healthcare workers. The AHA sent a letter to U.S. Attorney General Merrick Garland in March and urged him to support enhanced protections for hospital workers similar to airline and airport workers.

Rick Pollack, president of the hospital association, noted that healthcare workers have been attacked more frequently during the COVID-19 pandemic. “The surge in assaults against the health care workforce cannot continue and we must do everything we can to protect them,” Rick Pollack, president of the hospital association, said in a statement.

U.S. Sen. Tammy Baldwin, D-Wisc., has introduced legislation directing the U.S. Occupational Safety and Health Administration to require healthcare and social service organizations to create workplace violence prevention plans. The U.S. House of Representatives passed a similar bill sponsored by Rep. Joe Courtney, D-Conn., last year.

The rise in violence affects all of emergency medicine, Skog and others said.

“This is not just a physician problem,” he said. “This is a whole emergency department staff problem.”