When Mike Huss receives an alert from a panic button or a phone within the Allegheny Health Network, he and his team are ready to take immediate action.
“If you look at it, some of it was just verbal abuse. Some of it was physical abuse, with people beating, punching, biting healthcare workers,” Huss said. “Probably the most arrests we make are aggravated assaults on healthcare workers.”
Huss is Highmark Health’s Director of Corporate Safety and Worker Safety. He is responsible for the safety of Highmark and AHN employees, patients and members.
As one of more than 500 members of the system’s security team, he has witnessed an increase in violence in healthcare settings, from rude or belligerent comments to assaults.
He’s not alone in noticing this: The Western Pennsylvania Regional Chief Medical Officers Coalition, a group of health system leaders who first came together to work together before the pandemic, sent a letter to the public last month condemning it. an aggressive mode.
“I think we’re seeing an increase in violence in the community, and I think that spills over into our hospital setting,” Huss said. “Sometimes your hospital visits can be dramatic. People can be having the worst day of their lives. But patients and families need to understand that these healthcare professionals are here to help them.”
The coalition’s letter, signed by 15 chief medical officers from across the region, cites “additional reports of threats, physical interactions, brandishing of weapons and harm to providers or others.”
The letter marks the second time the coalition has asked the public to consider the impact of violence on health care. In April 2022, the group expressed a similar message, asking patients and their families to hold back their frustration.
“The situation is not improving,” said AHN Chief Medical Officer Dr. Don Whiting.
“When people are in the hospital, they’re at their most vulnerable and unwell, and they tend to lash out,” Whiting said. “But it ends up making it harder to care for people because the people who care for them are terrified.”
A recent AHN health survey found that 89 percent of the system’s emergency room residents had been threatened by a patient or family member in the past year, Whiting said. That pattern of behavior has gotten worse since the start of the pandemic, he said.
“The number of negative interactions between patients and healthcare providers was at baseline levels in 2018, but that has probably doubled since the pre-COVID-19 years,” he said. “In the past year, 36% of our residents have been threatened by a family member or patient at least once. In nursing, 48% of our nurses have been assaulted by a patient or patient family member in the last year.”
UPMC’s chief medical officer, Dr. Donald Yealy, said the frequency of negative events was increasing based on internal reports.
“A lot of our observations on the ground are informal. We have verbal reports from people working in health care, we have written reports that they follow as part of their day-to-day duties, and their official actions,” he said. “This is not something that is isolated to UPMC or Western Pennsylvania. Nationally, these reports of threats of violence or actual acts of violence against healthcare workers are increasing.”
In some cases, this trend dates back to pre-covid. From 2010 to 2020, the incidence of nonfatal workplace violence against healthcare workers more than doubled, according to data compiled by the Pennsylvania Association of Hospitals and Health Systems.
At Excela Health, chief medical officer Dr. Carol Fox cites “a lot of stress and anxiety” in healthcare.
The system has experienced some notable incidents of attack activity over the past year. At Excela Westmoreland Hospital in May, a patient involved in multiple burglaries in the Greensburg area rushed a security guard and tried to take his gun away.
In December, a Hempfield man was arrested on terrorist threat charges for making threatening remarks to Excela Health Latrobe Hospital and its staff in the emergency room.
“In the past few years, we’ve seen more and more people using extreme language, being more aggressive, intimidating, and so on,” she said. “People get frustrated and angry, sometimes they attack verbally, sometimes physically.
“It’s been very difficult for our employees.”
There were incidents all over the region. In December, a patient was accused of severely assaulting a nurse after she was taken to AHN Allegheny Valley Hospital in Natrona Heights for examination. In November 2021, a patient at UPMC Mercy Hospital was arrested for allegedly threatening hospital police with a gun.
cause and effect
Fox said staffing shortages across the health care industry could be a factor in the increase in attacks.
“Hospitals are under the same stress and stress. It’s no secret that workforce issues are there, and there isn’t a single hospital in our region that isn’t affected by workforce issues,” she said. “This often leads to increased wait times for people who are already frustrated.”
ER wait times vary by location and time of day. At Allegheny Health Network on Wednesday afternoon, emergency room times at various locations ranged from nearly three minutes to more than an hour. At UPMC Children’s Hospital on Wednesday, the wait time was about two hours. Excela Health did not respond to a request for information on wait times.
The general stress of the pandemic could also lead to an increase in violence, Fox said.
“It’s always been there, but with the pandemic and all the anxiety associated with it, I think we noticed an escalation at the time,” she said. “I just think, given everything that’s been or has happened to our community since then, economically and otherwise, I think we’ve definitely noticed a marked increase in these kinds of things.”
Early in the pandemic, much of the public was “thanking healthcare workers and expressing gratitude,” Yealy said.
“That sense of gratitude seems to have evaporated, or become less prominent. The backdrop of that (frustration) is what we’re seeing now,” Yerli said. “I think (violence in health care) was becoming more common in the years before the pandemic, but after the pandemic started, it seems to be accelerating now.”
Chris Chamberlain, vice president of emergency management for the Pennsylvania Association of Hospitals and Health Systems, pointed to a lack of behavioral health services in the outpatient community as a reason for the trend.
“The increasing number of people who need outpatient behavioral health services are forced to visit their local emergency room, and in some cases this is a contributing factor,” Chamberlain said. “It’s hard to say if it’s actually a thing, but I think we’re seeing a confluence and various issues that lead to these things happening.”
At AHN, clinical staff attend crisis prevention training, Huss said.
“We mock up scenarios and try to get everyone to understand each other’s roles and how we can de-escalate situations as they arise. I think that goes a long way in training us all,” he said. “A lot of it is communication and how to deal with someone who might be in crisis. No matter how hard we try to build rapport with that person, offer them comfort when they need it, reduce their anxiety levels, the best motivation we have is to be able to Communicate with people.”
Managers in each department received “extensive” training, although each was taught strategies for handling potential incidents, Whiting said.
“We’ve made a concerted effort to make sure our people feel safe when they’re getting in and out of the parking lot, commuting and things like that. Threats and things like that are also taken very seriously because we want our people to feel as safe as possible while working here,” Whiting said . “We have a very, very good security force and we have a wellness program in place for the whole organization.”
Excela and UPMC also have de-escalation training and are also increasingly focused on safety, according to their chief medical officers. UPMC declined to comment on safety details for “patients, visitors and staff”.
“We make sure the entry points and exit points are staffed, they’re monitored and we have security protocols in place,” Yealy said. “Fifteen years ago, that didn’t really happen. Hospitals were wide open. You could pretty much come in and out as you wanted.”
Yealy added that security procedures are not meant to prevent patients from entering the hospital.
“It’s about making sure people feel safe when they absolutely need to visit,” he said. “We ask, ‘What’s the best way to both provide safety and make sure people know they’re safe?'”
looking to the future
Some health care leaders hope the legislative action will help slow the tide of attacks.
A federal bill, the Health Care Workers Freedom from Violence (SAVE) Act, introduced in 2022, would introduce tougher penalties for those who become belligerent towards health care workers and improve training by providing grants to hospitals. The bill was referred to the Crime, Terrorism and Homeland Security subcommittee in November.
“This will stop violence against healthcare workers by making it a federal crime, just as they have done to airline employees,” Chamberlain said.
Attacking healthcare workers is already a state crime.
Beyond legislative action, Chamberlain anticipates that many factors will have to come together to reduce violence in health care.
“I think the number one is that the hospital is going to step up in terms of environmental safety, doing risk assessments, having safety plans, doing de-escalation training, strengthening safety where possible and these types of proactive, pre-emptive programs,” he said. “Increasing the number of people entering the labor force would help overall, for a variety of reasons.”
Whiting said he would like patients to have more understanding of the difficulties hospitals are facing.
“I just want to say to patients: When (you) come to the hospital, keep a positive attitude,” Whiting said. “We’re here to help them, and we’re doing what we can to do that. Having trust is the fastest way to help get better.”
Julia Maruca is a staff writer for Tribune Review. You can reach Julia at firstname.lastname@example.org.