Researchers urge greater hospital security to curb patient violence

Security personnel needed in EDs. 
Image: Daily Telegraph

by Anne Crawford

Australian hospital emergency departments should employ security personnel to counter the increasing number of violent incidents occurring there, a Monash University and Alfred Hospital study recommends.

Researchers from The Alfred’s Emergency and Trauma Centre have also called for a register to be established to alert emergency department (ED) staff across hospitals about repeat perpetrators of workplace violence to try to prevent future incidents.


Their study, published in Emergency Medicine Australasia, reviewed episodes of workplace violence by adult patients in The Alfred’s ED in the three years to 31 December 2015. The study included data collated by security personnel.

“There’s a zero tolerance policy towards workplace violence but it’s still happening very frequently,” Dr Alex Olaussen said. “There was a huge need for this study to address the issues.”

Dr Olaussen, a medical doctor working at the Alfred Hospital, and research fellow with the National Trauma Research Institute (NTRI), said workplace violence could have significant, lasting effects on staff.

“There’s a lot of literature about the impact and costs to the workforce, particularly in the United States. There’s the risk of burnout, staff quitting and not enjoying work,” he said.

“The Alfred has a 24-hour presence of security force but that’s not necessarily the case in smaller hospitals,” Dr Olaussen said. “They rely on calling in the police, which is not optimal.”

The study found that there were 1853 violent episodes over three years, equating to almost two episodes a day. Of these 1668 required physical force to control the offender; 923 required chemical restraint (tablets or injections) and; 650 required mechanical restraint (e.g. having wrists secured to a bed).

Only 144 or 8% of perpetrators responded solely to the presence of security personnel.

“There’s an idea in the literature than security presence alone as a show of force could reduce the use of chemical or mechanical restraint but we didn’t find this,” Dr Olaussen said.

The episodes ranged from ‘Code blacks’, in which the offender was armed, to incidents in which the staff felt threatened and alerted security before the situation escalated.

“As far as we’re aware this paper is the first to characterise how these violent incidents were managed by using security personnel data,” Dr Olaussen said.

Notably, almost half the episodes involved repeat offenders.

“The fact that there are so many repeat offenders would have implications both within the hospital and for other hospitals. Ideally we’re asking for a state-wide or national-wide registry that could alert hospitals early on.”

First author on the paper was Professor Biswadev Mitra, Head of Clinical Research at the NTRI.

This the third in a series of studies by the researchers about workplace violence. A previous study of Alfred Hospital ED incidents published in April this year showed a significant increase in episodes over three years. It found the majority of violent patients were affected by drugs and/or alcohol (without a psychiatric diagnosis). Most (60%) were male with an average age of 38 years.

The recent paper recommends that all Australia EDs have well-resourced security staffs. It
calls for Australasian College for Emergency Medicine (ACEM) policy on the topic to increase preventive strategies towards zero prevalence of workplace violence in all EDs.

Reference:
Mitra B, Nikathil S, Gocentas R, Symons E, O'Reilly G, Olaussen A. Security interventions for workplace violence in the emergency department. Emerg Med Australas. 2018 Jun 25. doi: 10.1111/1742-6723.13093. [Epub ahead of print