Hospitals seek to prevent, mitigate attacks on clinical staff

James Phillips was working as an emergency physician at Beth Israel Deaconess Medical Center in Boston in 2015 when a man walked into Brigham and Women’s Hospital across the street and shot and killed cardiovascular surgeon Michael Davidson.

Though Phillips was physically unharmed, the shooting served as a reminder of the several times he had been assaulted on the job.

There was one time when a patient spat blood, contaminated with hepatitis C, on him. And another when a patient threw an iPhone at his face.

“It started me on this pathway of looking back on my own early career and realizing that I’ve been the victim of violence several times,” recalled Phillips, now the chief of disaster medicine for the American College of Emergency Physicians, or ACEP, and chief of disaster and operational medicine at George Washington University.

Since the Boston shooting, attacks against healthcare workers have continued to rise.

Healthcare workers were five times more likely than those in other industries to be physically attacked while at work in 2018, according to the Bureau of Labor Statistics.

Some providers say the COVID-19 pandemic made violence worse.

In early 2023, the Massachusetts Health and Hospital Association issued a report and “call to action” on workplace violence at healthcare facilities in the state, based on an ongoing monthly survey of member hospitals. The organization saw an uptick in violence as the pandemic waned and hospital patient volume surged – a violent incident was reported every 38 minutes in 2022, up from every 57 minutes in 2020.

The American Hospital Association said healthcare workers experienced a “sharp increase” in violence after the pandemic, making it “more difficult for clinical staff to provide quality patient care.”

Phillips and ACEP now study violence against physicians. In ACEP’s annual membership poll this year, 91% of respondents said they or a colleague had been threatened or attacked in the previous year.

The data makes healthcare the “most violent non-law enforcement industry in America,” Phillips said.

Hospital groups, providers focus on guidelines

Healthcare workers are in a unique position because, particularly in emergency medicine, they have an obligation to treat people who might potentially put them in danger.

“I think it would be helpful to have some medical-legal guidelines that that allow us to know what our rights are once we’ve been attacked in the emergency department in terms of actions that can be taken against that person,” Phillips said. For example, would clinicians be held liable for abandoning the patient if they refuse to treat someone who is belligerent?

Seeking answers, physician and hospital organizations have created guidelines for preventing and managing violent interactions.

Other groups, like the MHA, have adopted codes of conduct for violence prevention.

MHA’s document calls for specialized training when appropriate — particularly for psychiatric and dementia patients — and post-incident debriefings by management, according to Patricia Noga, MHA’s vice president of clinical affairs.

“It was a template for, and guidelines for hospitals then to take and develop their own,” Noga explained.

In addition to the guidelines, hospitals should consider architectural redesigns, like rethinking the proximity of providers to room exits, and having at-risk staff wear duress alarms, Noga said.

Other strategies hospitals should consider include beefing up security, hardening entrances, providing escorts through the building or parking areas and adopting surveillance technology. However, there’s no good data on which strategies work better than others, she said.

A few states, notably California, have enacted policies requiring healthcare organizations to take concrete steps toward improving worker safety.