356 Workplace Violence in the Emergency Department: Staff and Law Enforcement Disagreement on Reportable Crimes

Abstract

Violence in the emergency department (ED) is a common and serious threat to staff and remains underreported. According to a recent survey at our institution, 37.2% of ED staff experienced physical assault in the 6-months prior, with only 26.2% of non-security staff victims indicating they had formally reported the incident. Incident reporting processes can be cumbersome, and staff often may not know what acts constitute reportable violence. To identify barriers in reporting, we hypothesized that ED staff may not fully understand reportable crimes and their understanding may differ from those of law enforcement officers (LEO). An anonymous REDCap survey with four hypothetical case scenarios (Table 1) was sent to ED staff at our academic medical center, as well as LEO at the local police department. Respondents were asked to indicate whether they considered any of the scenarios to be reportable as a crime if it occurred in the ED. Chi-square analysis was used for comparison. The study was deemed exempt by Mayo Clinic Institutional Review Board. 77 LEO and 261 ED staff completed the survey. Both groups were equally likely to believe that a reportable crime occurred in scenario 1 (LEO: 26.0%, ED: 32.2%, p =.37) and in scenario 2 (LEO: 97.4%, ED: 95.4%, p = .65). However, the two groups differed in scenarios 3 and 4. In scenario 3, only 20.8% of LEO believed it represented a reportable crime, compared to 43.7% of ED staff (p <.001). Similarly, more ED staff believed that a reportable crime occurred in scenario 4 compared to LEO (LEO: 66.2%, ED: 81.2%, p =.009). There was disagreement between ED staff and LEO on what actions in the ED constitute a reportable crime. Additionally, there was variability among both groups’ answers in three of the four scenarios. While the scenarios were hypothetical, they are not unrealistic in our specialty. Improvement interventions could be targeted at ED staff around the law and for LEOs to understand the unique environment of the ED and patient responsibilities. As health systems seek to improve workplace safety, it is important to consider the barriers to reporting violent incidents, including staff understanding of what acts may even constitute a crime.Table 1Case scenariosScenario 1: An 85-year-old man with known dementia is transferred to the ED from his nursing home for back pain and is not oriented to the year or his present location. He becomes agitated and punches a nurse attempting to obtain his vitals.Scenario 2: A 25-year old man is brought into the ED by EMS with the complaint of broken teeth after getting into an altercation and he appears to be intoxicated. He spits blood-tinged saliva into the face of the phlebotomist performing venipuncture.Scenario 3: A 70-year-old female comes into the ED for abdominal pain. After a lengthy workup and prolonged stay, she begins showing signs of delirium and makes threats to find her doctor’s house upon discharge and harm him.Scenario 4: A 1-year old is brought into the ED by his parents for a fever, rash, and upper respiratory symptoms. Upon hearing that a viral infection is the likely culprit and no further diagnostic studies will be ordered or antibiotics prescribed, the mother becomes increasingly angry and eventually throws a chair in the room, narrowly missing the medical student. Open table in a new tab