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Lynch: Violence in the ER: A Big Problem Getting Worse

By Tom Lynch

Tuesday, December 4, 2018 | 571 | 0 | min read

Men and women who yearn to follow in the footsteps of Hippocrates, Galen and Banting are taught many things in med school, but there is no course called "Violence in the ER, and What to Do When it Happens to You." 

Until recent times that hasn’t been much of an issue for the doctors and nurses who take care of us when we need critical care in a hurry. But in the 21st century, violence in the emergency room has become less the exception and more the rule.

In a 2018 American College of Emergency Physicians survey of 3,539 ER doctors, 47% reported being assaulted at work, 60% of those within the last year.

Why is this happening? According to ACEP, there are at least three problems with no easy solutions causing the sharp uptick in ER violence.

First, America has a tremendous shortage of psychiatric beds for people in profound mental stress. That means people in serious need of behavioral and mental health care can languish on a gurney in the ER for days, even weeks until a bed becomes available somewhere.

Second, patients who’ve become addicted to opioids often show up in the ER demanding medication, and when they don’t get it things can get dicey in a hurry.

Third, hospitals haven’t done enough to protect physicians and nurses from attacks by highly stressed knife- and (sometimes) gun-wielding patients. Some hospitals have installed metal detectors at entrances, but the detectors and the labor required to screen incoming people can be pretty expensive, especially to a cash-strapped community hospital.

Even with the metal detectors, many doctors in the ACEP study reported being kicked, punched, bitten and spit upon by deranged patients. This is a difficult issue for hospital risk managers to confront successfully.

We’ve known for many years that nurses and nursing aides are much more likely than other professionals to be victims of violence in the workplace. According to the U.S. Bureau of Labor Statistics, “intentional injury’’ by another person rose nearly 50%, from 6.4 per 10,000 hospital workers in 2011 to nine per 10,000 hospital workers in 2016, the most recent year of data. The rate across private industry is 1.7.

The Occupational Safety and Health Administration has analyzed this and published guidelines for dealing with it. But the ACEP survey is one of the first to shine a light on the stark potential for violent harm confronting emergency physicians.

One wonders if the threat of violence in the ER will dissuade med school graduates from specializing in emergency medicine. This would certainly be unfortunate, because a shortage already exists for rural ER physicians as documented in a June 2018 study published in the Annals of Emergency Medicine.

At the time of the study, more than 27% of U.S. rural counties did not have emergency medicine clinicians, and 41.4% of counties did not have any emergency physicians reimbursed by Medicare fee-for-service Part B, according to the study.

We’ll continue to follow this phenomenon and occasionally report on progress, or lack of it, in protecting these highly trained and dedicated lifesavers.

Tom Lynch is a principal with Lynch Ryan & Associates, a Massachusetts-based employer consulting firm. This column was reprinted with his permission from his Workers' Comp Insider blog.


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