Detroit Area Hospitals Fight to Stem Emergency Room Violence

July 1, 2013

By Karen Bouffard, – ixzz2ZQJcD8Wp

Hospitals in Metro Detroit and across the country are beefing up security to protect their workers from emergency room violence.

ER doctors and nurses are pushed, shoved, hit and even bit, according to recent research, including a six-hospital study by the head of emergency medicine for Beaumont Health System and an ongoing national survey by the Emergency Nurses Association.

Experts cite the large number of mentally ill, intoxicated and drug-addicted patients seen in emergency departments. The ER can be a pressure cooker, and the stress is sometimes exacerbated by overcrowding that can lead to frustrating waits for treatment.  

“Nobody wants to talk about the number of incidents within their emergency departments, (but) there’s no question it’s a big problem,” said Dr. Terry Kowalenko, health system chair of emergency medicine for Beaumont Health System. “It doesn’t matter if you’re male or female. Age doesn’t matter, experience doesn’t matter, it just happens.”

The matter has gotten the attention of Michigan lawmakers. The Senate passed a bill in June that would make assaulting an on-duty health worker punishable by the same penalty as assaulting a police officer or a firefighter: up to four years imprisonment and a $5,000 fine. At least 26 states have passed similar laws.

“It happens at least once a night that somebody is pushed away or spit at — that’s very common,” said Regina Waller, a registered nurse and night manager at Beaumont in Royal Oak. “Employees have been kicked, grabbed, tackled — you name it, it’s happened.”

Beaumont-Royal Oak, Henry Ford Hospital, St. John Hospital and Medical Center, Providence Hospital and the Detroit Medical Center’s Receiving Hospital all have metal detectors that patients and visitors must pass through to enter the emergency department.

Most have additional layers of security. In Royal Oak, for example, Beaumont employees wear personal panic buttons and police make routine sweeps of the emergency department with Starr, a bomb-sniffing German shepherd.

“People have a tendency to calm down when the German shepherd shows up,” said Sgt. Bill Ferreras, a Beaumont security officer.

Hospital spokesman Alton Gunn said Detroit Receiving Hospital’s security team is trained by the military and former police officers and “are a very big presence here — they carry hand-held metal detectors.

“We’re well secured with cameras throughout the hospital that cover every inch of the grounds from the gift shop to the parking lots and they’re monitored by security guards. We’re well secured here.”

Lansing’s Sparrow Health System installed metal detectors in its emergency departments at Sparrow Hospital and its St. Lawrence campus after an assault on a resident physician last summer.

“The patient pulled a knife on him and cut him,” said Dr. Timothy Hodge, executive medical director for emergency services at Sparrow. “It could have been much worse. The cut was to his neck. It was a serious cut.”

Sparrow put in the metal detectors and also beefed up security presence inside and outside of the emergency department.

“The patients we see come in often are significantly ill or injured, often emotionally stressed, and sometimes intoxicated,” Hodge said. “We see society’s highest-risk players.

“There’s not one (worker) that does not celebrate having that (metal detector) there, and many patients celebrate having it there. It creates a safer environment.”

The cost of ER violence

In a study published in the January issue of the American Journal of Emergency Medicine, Kowalenko, a professor of emergency medicine at Oakland University’s Beaumont School of Medicine, and colleagues from the University of Cincinnati surveyed 213 emergency department workers monthly at six hospitals in Michigan and Ohio.

Over nine months, the hospital employees reported 827 violent events, including 601 threats of violence and 226 actual assaults. The stress that resulted, the study reported, significantly affected workers’ productivity and their ability to think on the job.

The Emergency Nurses Association’s Institute for Emergency Nursing Research surveyed 7,169 emergency nurses between May 2009 and January 2011 and asked if they had been verbally abused or physically assaulted on the job within the previous seven days. They found 12.1 percent had been physically assaulted, with or without verbal abuse, and 42.5 percent had been verbally but not physically abused.

Both Dr. Kowalenko’s and the Emergency Nurses’ studies found significant under-reporting of ER incidents. Assault victims filed safety reports only 42 percent of the time in Kowalenko’s study, and police reports 5 percent of the time. And the Institute for Emergency Nursing Research found that 65.6 percent of nurses who were victims of physical abuse did not file a formal report.

Nick Radu, director of Henry Ford Health System’s Police Authority, said educating workers about the need to report abuse is an important component of their approach to combatting the problem.

“In the past, nurses and doctors would forgive those behaviors because they knew it came with the territory, but now …we’re trying to change that perception,” Radu said. “You’re not here to be anybody’s drum. We’re trying to make sure everybody’s educated that …if there’s abuse they should report it, boundaries need to be set.”

At the University of Michigan Medical School, every student is required to do a rotation in emergency medicine — and that involves taking Dr. William Wilkerson’s class on violence.

“I call it verbal kung fu,” said Wilkerson, clinical associate professor of emergency medicine at U-M Medical School. “How to stand in a non-threatening stance, your tone of voice, your posture. We teach them how to not be threatening, to not stare down somebody.

“I teach them how to side-step when somebody is charging at you or what to do if somebody’s trying to pull your hair.”

Wilkerson, who’s practiced emergency medicine for 30 years, said he doesn’t think the problem is worsening. But workers and hospitals are doing a better job of responding to it.

“When I first came to the (university), you could just walk through the emergency department,” Wilkerson said. “Now everybody gets a name tag, you have to be buzzed in, we have measures that show you can’t just walk in and do whatever you want.

“We’re certainly seeing a lot more homeless people, a lot more intoxicated homeless people, but overall we have a little better handle on it now.”

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