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