Emergency Department Psychiatric Patient Violence: Diminishing the Risk

Abstract

Problem: Research supports that emergency department (ED) workplace violence (WPV) involving psychiatric patients is a serious problem. While information on successful prevention strategies is limited, a first step in the process is to identify contributing factors. Objective: The Haddon Matrix, a framework that has been shown to be effective in identifying factors related to WPV in the ED, was used to conduct an observational analysis of a local ED to evaluate WPV related to psychiatric patients. Design: The principal investigator used the Haddon Matrix to obtain descriptive observation and analysis of events in a local community ED observational unit. The observation and data collection process involved psychiatric patients, health care providers, and the environment. Sample methods: Patients included those placed in the observational unit for ED psychiatric evaluation who were between 18 and 65 years old. The health care team providing direct patient care was also observed. Results: In this local community ED, 20% of psychiatric patients were involved in WPV during the 8-week observation period. Management included chemical restraints, physical restraints, security involvement, and a combination of the above. The most frequently used management was security participation, relied upon 81.8% of the time. Chemical restraints were used 63.6% of the time. Physical restraints were relied upon 9.1% of the time. Specific factors such as deescalation techniques contributed to the absence of violence. Factors such as ignoring patients, long wait times, and inconsistent processes were associated with WPV. Other concerns observed included distractions related to the use of personal cell devices and Internet that can lead to a delay in responding to escalating patients. Technology has been shown to enhance patient care, though its proper use is imperative for safety.Recommendations: Ensuring that staff has a consistent process and that all are following the protocol will help decrease the risk of WPV. Maintaining a security presence and the early use of de-escalation techniques were also associated with a lower level of WPV. It is recommended that technology be used with caution to enhance patient care but not delay response time or treatment of patients.