Hospital Workplace Violence

October 13, 2017

Author: Jackie Gatz, Vice President of Grant Management and Safety

Health care providers — especially frontline staff within hospital emergency departments — increasingly are faced with violent encounters by patients and visitors. The U.S. Bureau of Labor Statistics found that 52 percent of all workplace violence incidents recorded are in health care. The current health care environment in Missouri, including a shortage in psychiatric beds resulting in boarding in the emergency department, the expanding opioid crisis which prompts unstable and combative patients seeking treatment, and the increased prevalence of weapons and narcotics among patients, creates an unstable environment for frontline staff. A 2017 survey of Missouri hospitals showed that 50 percent of respondents identified violence or violent intruders as a top-three internal threat in their hazard vulnerability analysis. Further, MHA’s recent analysis of hospital claims data in the state show that, during 2016, mental health and substance abuse patients spent more than 550,000 combined hours in Missouri’s EDs while waiting for stabilization and discharge or transfer to an appropriate care setting. This is the equivalent of 63.1 years.

These issues are compounded by the complexities that arise when law enforcement presence is necessary to respond to incidents in the care environment. Further, officers may seek to serve warrants, obtain blood draws, or question suspects or witnesses receiving care. These interactions with law enforcement raise questions about the respective rights and obligations of the hospital, its staff, patients and the police. Law enforcement officers may not fully appreciate the restrictions on patient information and access within the hospital environment, leading to conflict between officers and staff. Frontline staff are often hesitant to challenge police on these HIPAA- and EMTALA-related cases. The recent incident in Salt Lake City drew national attention to this uncertain relationship. MHA has developed an issue brief to outline the nuances related to this within Missouri.

Recognizing these substantial challenges, MHA convened a task force to guide and direct a fall 2017 listening tour of executive and frontline staff to inform the development of new resources to address the challenge. This effort is a part of the broader S.A.F.E.R. initiative — an MHA effort to provide resiliency resources under five pillars. The initiative includes safety programs, approaches to safer care, facts to inform decision-making, educational programming and regulatory requirements. These resources, and MHA’s increased focus on resiliency, are intended to enhance support and services for personal, organizational, community and patient safety. S.A.F.E.R. provides education and assistance to hospitals on workplace and community violence, as well as emergency preparedness.

More information on the S.A.F.E.R. program is available here.