Administration of Emergency MedicineAn Association Between Occupancy Rates in the Emergency Department and Rates of Violence Toward Staff
Introduction
The National Institute for Occupational Safety and Health has long recognized violence as a workplace hazard for health care workers (1). Among the locations for violent events to take place in the health care setting, the emergency department (ED) and treatment rooms are among the most frequent 2, 3, 4. Reported acts of violence towards ED staff range from verbal abuse to even death, with nurses and physicians being the most common victims 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Violence is now recognized as an accepted occupational hazard for emergency physicians 13, 14. The effects of the hostility in the ED upon staff are significant. Staff have been shown to suffer emotional symptoms similar to post-traumatic stress disorder, job dissatisfaction, and early feelings of burnout, while hospitals suffer the financial burden of decreased productivity and excessive lawsuits 8, 10, 11, 14, 15. The current rate of violence towards staff in the ED is reported to be 2.0 to 2.8 incidents per 1000 patients, and rising 11, 16, 17, 18.
Studies have attempted to classify perpetrators of violence in hopes of finding a source 19, 20, 21. Surveys have questioned ED staff as to their opinions of contributing factors to acts of violence. Among the most frequently reported causes are alcohol abuse, psychiatric disease, and long waiting times 4, 8, 12, 17, 19, 22, 23, 24, 25. Whereas investigations into wait times of violent perpetrators have produced mixed results, an under-investigated cause of violence in the ED is crowding 16, 17, 19, 21, 26. Although to our knowledge, no studies to date have directly investigated the impact of occupancy on violence in the ED, studies conducted on crowding in psychiatric hospitals have shown that violent incidents are more likely to occur at a higher occupancy level (27).
ED crowding is a problem affecting everyone involved. According to the Centers for Disease Control and Prevention, two-thirds of United States metropolitan EDs experience crowding (28). Hospitals bear the cost of increased patient length of stay (LOS) and mortality associated with crowding 29, 30, 31. Patients suffer from compromised care manifested by delayed antibiotic and analgesic administration 32, 33, 34, 35, 36. Staff are subjected to high stress environments and commit an increased number of medical errors as a result (37). One study suggests violence to be an effect of crowding, but fails to provide objective measurements of the association between the two (38). The purpose of this study is to determine the relationship (if any) between increased ED occupancy rates and the rate of violence toward ED staff.
Section snippets
Methods
The study hospital is a 636-bed, private, not-for-profit, tertiary care university teaching hospital and Level I trauma center that treats approximately 70,000 patients each year in the ED. The ED has 44 beds, and cares for a diverse patient mixture consisting of health maintenance organization clients, Medicare and Medicaid patients, the uninsured, and the privately insured. The ED charts are completed using an electronic template system and occasional dictation.
An institutional review
Results
The ED saw a total of 220,004 patients over the 42-month study period, with 278 documented violent incidents (Figure 1). The calculated violence rate was 1.3 incidents per 1000 patients. When comparing the occupancy rates of violent days (mean 95%, SD 26%) vs. non-violent days (mean 86%, SD 24%), a statistically significant association was found between occupancy rate and the rate of violence toward staff (p < 0.0001). In addition, surrogate measurements for crowding, including
Discussion
Whereas the crowded conditions in the ED and their negative effect on patient care are published routinely in the Emergency Medicine literature, receiving little attention are the effects this problem is having on hospital staff 29, 30, 31, 32, 33, 34, 35, 36. Other studies have long recognized violence as an occupational hazard for emergency physicians, but until now have failed to provide an objective measure of association between the two (14). The results of our study suggest a correlation
Conclusion
The current study is the first to offer an objective measurement of an association between a crowded ED and violent acts toward staff. We recognize that violence in the ED is a complex issue with multiple causes, and although we cannot cite crowding as a specific cause for violence, an interesting correlation has been identified. Although studied retrospectively in a single institution, we found that crowding, across multiple measurements, is higher on days in which a violent event occurs when
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PREVALENCE AND PREDICTORS OF POSTTRAUMATIC STRESS DISORDER, DEPRESSION, AND ANXIETY IN PERSONNEL WORKING IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW
2022, Journal of Emergency MedicineCitation Excerpt :Distressing events include those involving the death of a child, exposure to severely injured victims of transport accidents, making a medical error, and experiencing workplace violence (2,3). Compared to other health care settings, ED staff face higher risks of physical assaults, especially when the ED is crowded (4,5). Exposure to stressful and traumatic workplace events when providing routine emergency care can lead to burnout and other trauma-related mental health conditions, such as posttraumatic stress disorder (PTSD), depression, and anxiety (6).
Association Between Hospital Bed Occupancy and Outcomes in Emergency Care: A Cohort Study in Stockholm Region, Sweden, 2012 to 2016
2020, Annals of Emergency MedicineCitation Excerpt :Taken together, they result in an increased workload in the ED beginning when bed occupancy reaches 85%, thus increasing the risk of ED crowding and negatively affecting patients and staff.17,18 For example, time-critical interventions are delayed,19 adverse events for elderly patients increase,20 and violence toward staff occurs more frequently.21 These findings highlight the ED’s dependency on the hospital’s inpatient care and the importance of viewing the ED as part of a larger system dependent on input, throughput, and output.22
Deriving a Framework for a Systems Approach to Agitated Patient Care in the Emergency Department
2018, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :Finally, logistics play a major role for management of agitation at both the ED environment and the broader health care system levels of care. Consistent with existing literature, we found crowding, hallway space, physical layout, security policies and procedures, and ambulance bay/triage systems to be vital targets for improving safety.56,57 However, our results indicate that local interventions for the work environment may be inadequate to address ED agitated patient care from a systems perspective.