Four Precautions to Prevent ED Violence

Scott Wallask, March 2, 2010

When it comes to workplace violence in hospitals, emergency departments (EDs) act as a potential powder keg.

"The emergency department is a funnel into your institution," says Fredrick Roll, MA, CHPA-F, CPP, president of Healthcare Security Consultants, Inc., of Frederick, CO, and one of the country's leading experts on hospital security.

"Patients coming to the ED don't really want to be there in the first place," Roll says. "Something has happened to them to bring them to the hospital."

Undiagnosed psychiatric cases also pose a threat to the 24/7 environment of an ED. Whereas patients with behavioral health issues might have used standalone clinics before, the failings of these "doc-in-a-box" settings during the recession have driven more behavioral patients to the ED, he says.

Roll will be a featured presenter at the 4th Annual Hospital Safety Center Symposium, which takes place May 6–7.

Assess patients for possible violence

Annual reviews of security plans and incidents offer hospitals an opportunity to improve the safety of ED workers. Roll provides the following four suggestions for preventing ED violence:

  • Tighten access control. Evaluate every entrance—such as entries to treatment rooms, reception areas, and outside entrances—and determine if access should be tightened to each. Also, consider whether receptionists and intake nurses should be protected with glass barriers or other measures.

  • Evaluate lockdown protocols. A key is to know when you initiate an ED lockdown. For example, if a domestic violence victim is brought into the ED and the aggressor is still at large, will that trigger a lockdown? A less drastic measure is to screen people coming into the ED waiting room.

  • Encourage employees and physicians to discuss incidents. Some physicians and nurses assume that violence comes with the job and don't speak up about it, Roll says. But assessing violence and fully reporting incidents can help your facility get a better grip on what's truly happening and how to enact prevention measures.

  • Assess patients for their violence potential. As part of the triage and admissions process, educate nurses and physicians to identify a patient's potential for violence. Talk to the emergency medical technicians and police officers who bring patients in about the circumstances surrounding an injury or condition, and enter this information into the patient's record. Often these details are ignored, Roll says, but if the particulars are part of the patient assessment process, providers become more informed and can take steps to begin verbal de-escalation if needed to prevent problems.
Scott Wallask Scott Wallask is senior managing editor for the Hospital Safety Center. He can be reached at
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