THURSDAY, June 10 (HealthDay News) -- More and more violent crimes are occurring in America's hospitals, clinics and other health care facilities, according to a new alert issued by the Joint Commission, an independent health care oversight group.

Since 2004, there have been "significant increases in reports of assault, rape and homicide, with the greatest number of reports in the last three years," the group said in its "Sentinel Event Alert" released last week, the latest in a series of alerts on serious adverse events occurring in health care settings.

According to the Joint Commission's voluntary reporting system for these adverse events, there have been 256 assaults, rapes or homicides of patients and visitors to American health centers since 1995, with 110 of those acts occurring since 2007. And the report also noted that the actual numbers are believed to be significantly higher.

"Only a very small percentage of violent incidents are reported, so this is just the tip of the iceberg," said Russell L. Colling, a health care security consultant in Salida, Colo., who advised the Joint Commission on the report. "The reality is, there is violence every day in the emergency department."

Colling cited a number of reasons for the increase in violent outbreaks in health care settings, including an increase in drug and alcohol abuse and a lack of adequate care for psychiatric patients.

"In the last ten or fifteen years, the resources for the diagnosis and treatment of mental health patients have basically vanished, and that means hospitals often have to do intakes for all suspected psychiatric patients," he said. "In today's hospital environment, where there are often tremendous delays in treatment, these patients tend to get more agitated."

Another factor, said Colling, is that Americans are more likely to vent their frustrations about the flawed health care system.

"Patients today tend to feel more entitled," he added. "They feel that they have a right to immediate health care, and they don't like having to wait in line."

"If you put all those things in the mix, we just have a more volatile, stressful environment in hospitals than we've had in the past, and it's really no different from what's happening in other parts of society," he said.

The report identifies a number of contributing factors that were cited most frequently in the last five years. These include problems in the area of policy and procedure development and implementation; human resources-related factors such as an increased need for staff education; flawed patient observation protocols; communication failures; and deficiencies in the general safety of the environment.

The alert also spells out 13 specific steps that health care facilities should take to prevent violence, such as evaluating the facility's risk for violence by examining the campus, reviewing crime rates, and surveying employees about their perceptions of risk; as well as conducting thorough background checks of prospective employees. The report also recommends that facilities take extra security precautions in the emergency department, especially if it's in an area with a high crime rate or gang activity.

"The emergency department is the number one place, by far, where violence is likely to occur," said Colling, "but once a patient is admitted to the hospital, that risk of violence may travel to other areas, such as surgery and the intensive care unit."

Another expert agreed, adding that violent incidents reflect worsening health care resources.

"The health care system in this country is broken, with long waits in the ER, short staffing, and many other problems, and all of the players are under incredible stress, which means that those of us who consume health [care] are driven to the edge of our ability to cope," said Jane Lipscomb, a professor at the University of Maryland School of Nursing in Baltimore, who studies workplace violence in health care.

She said that the number of violent acts committed toward health care employees is also vastly under-reported. "In terms of assaults on staff, about five times as many incidents go unreported as reported," Lipscomb noted.

She said she agrees with the recommendations in the report, but for a hospital's violence prevention plan to be effective, "it can't be written or implemented from the top down. You really need the direct care staff to provide input on what happens on their units on a day-to-day basis."

More information

There's more on violence against nursing staff at the Emergency Nurses Association.