Hospital violence increasing, Joint Commission warns

Patients and staff can be perpetrators or victims. Hospital leaders are advised to evaluate the risks and to train employees how to handle potential problems.

By — Posted June 24, 2010

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Physicians and other health care professionals and staff need to be extra vigilant in efforts to prevent violent crimes in hospitals and other health care facilities, according to a new Joint Commission alert.

Patients, visitors and staff in recent years increasingly have been victims of assault, rape and homicide, said the commission's Sentinel Event Alert, issued in June (link).

Since 1995, there have been 256 reports of violent crimes to the commission's Sentinel Event Database, one of the nation's most comprehensive voluntary reporting systems for serious adverse events in health care.

The greatest number have occurred in the past three years: 33 in 2009, 41 in 2008 and 36 in 2007, the database analysis showed. And these figures are likely "significantly below" the actual number of these violent crimes, the alert notes.

"While not an accurate measure of incidence, it is noteworthy that the assault, rape and homicide category of sentinel events is consistently among the top 10 types of sentinel events reported," the alert states.

Visitors, staff, patients and intruders have been perpetrators.

"Unfortunately, health care settings are not immune from the types of violence that are found in other areas of our lives," Joint Commission President Mark R. Chassin, MD, MPH, said in a statement.

Colorado-based health care security consultant Russell L. Colling said increased drug use, limited mental health treatment services, time-strapped police officers unable to stay at a hospital after bringing someone to the emergency department, and crowded ED waiting rooms have "created an atmosphere that can breed violence."

But there are steps that hospital leaders and employees can take to minimize violent crime risks, he said.

"Hospitals need to secure areas and control access," Colling said. That extends beyond the facility's main entrance to include waiting rooms and treatment areas.

Hospital administrators can secure the property's perimeter through lighting, barriers and fences, and control access at entrances, exits and stairwells. They also can deter crime by positioning people at nursing stations to monitor who comes and goes.

In addition, hospital leaders can "improve communication between the back and the front of the house," Colling said. For example, staff can update patients who have been triaged and waiting for hours to be called for the remainder of their care. Also, patients' families should know what is happening with their loved ones' care, he said.

The Joint Commission's alert outlines 13 suggested actions organization leaders can take to prevent assault, rape and homicide, including:

  • Working with the security department to evaluate risks, including reviewing crime rates in the surrounding area.
  • Requiring that appropriate staff members are trained to respond to family members who are agitated and potentially violent.
  • Reporting crimes to law enforcement officers.
  • Conducting thorough background checks for prospective employees.

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