November 4, 2022
The American College of Emergency Physicians (ACEP) released the results of a survey of emergency physicians, conducted in July and August of 2022 by Marketing General Incorporated (MGI). It replicated a poll originally conducted in 2018. 2,712 ACEP members submitted responses.
89% of physicians surveyed said increased violence in the ED has negatively affected patient care, up from 77% in 2018. The physicians cited loss of productivity, emotional trauma, increased wait times, and less focus, as direct results of the violence.
Highlights from the MGI summary are below, lightly edited for length and headings added for clarity:
Increase in violence from 2018
Compared to findings from 2018, more emergency physicians have been physically assaulted in the ED (55%), and a higher percentage have witnessed assault of another individual (79%).
Which gender was assaulted more?
Men are more likely than women to report having been physically assaulted in the emergency department while at work (58% vs. 50%).
Who is committing the physical assaults?
[A]lmost all physical assaults against emergency physicians were committed by patients. Around three in ten assaults were committed by family or friends of the patient being treated by the physician (31%).
Male physicians are more likely to be assaulted by friends or family members of the patient or another visitor than female physicians.
What was the hospital response?
70% of emergency physicians physically assaulted said that their hospital administration or security responded to the assault.
[T]he hospital administration and security’s most common responses to physical assaults are to put a behavioral flag in the patient’s medical chart (29%) or to have the patient arrested, although fewer physicians report in the current research that patients were arrested (16%, down from 21%).
Were physicians injured?
33% have been injured as a result of the assault endured.
What is the frequency of assaults?
Two-thirds of assaulted physicians have been assaulted in the past year alone (66%). More than one-third of emergency physicians have been assaulted more than once during that time (36%). Compared to results from 2018, the frequency of assault on physicians has increased.
Female physicians are more likely to have been assaulted only once in the past year, while male physicians are more likely to have been assaulted two to five times in the past year.
Among emergency physicians who have been assaulted six or more times in the past year, more than half have been assaulted several times each month (59%). In fact, 36% were assaulted on a weekly basis and 4% were assaulted on a daily basis. Compared to the previous research, the frequency of assaults has increased.
How are physicians being assaulted?
Verbal assault, with threats of violence, are the most common form of assault (64%), followed by a hit or slap (40%). Emergency physicians also report being spit on, punched, or kicked.
Male physicians are more likely to be spit on or punched than female physicians.
Who is committing the assault?
Emergency physicians report that psychiatric patients and those seeking drugs or under the influence of drugs or alcohol are most often responsible for the assaults experienced (42% and 40%, respectively).
What are the effects on patient care?
Nearly nine in ten physicians agree that violence in the emergency department has harmed patient care (89%). This percentage has increased since 2018 (77%).
[L]oss of productivity, emotional trauma, increased wait times, and less focus are cited as the most common adverse effects on patient care due to emergency department violence.
Threats of harm
85% of emergency physicians report that a patient has threatened to return and harm them or emergency department staff, a slight increase since 2018.
How to increase safety
Emergency physicians indicate that the most important methods for hospitals to increase safety in emergency departments is to increase security; establish, communicate, and enforce clear policies; and report incidents of violence to the police.
Rankings are similar to those in 2018, except that physicians now believe an increase in staff in the emergency department is a better way to increase safety over reducing the number of public areas in the emergency department.
Recent increase in violence
85% of emergency physicians believe that the rate of violence experienced in emergency departments has increased over the past five years, with 45% indicating it has greatly increased. None of the physicians in the current study believe that the rate of violence has decreased at all.
Two-thirds of physicians indicate that COVID-19 has increased the amount of violence in emergency departments (66%).
Results indicate that COVID-19 has had a chilling effect on the trust levels between patients and physicians and staff in the emergency department, with 69% of physicians reporting that COVID-19 has decreased the level of trust between patients and physicians or emergency department staff.
[P]hysicians believe the biggest factors contributing to violence in the emergency department are a lack of adequate punitive consequences toward the attacker, behavioral health patients, and the absence of adequate protective mechanisms for staff. According to physicians, the lack of punitive consequences has become a bigger factor than behavioral health patients since 2018. Additionally, emergency department boarding is a now a larger factor than people seeking opioids.