May 1, 2019
Violence in the workplace continues to vex the health care industry, putting the safety of health care professionals at risk every day. Surgeons who attend to victims of violent trauma and share bad news with patients and families, and health care professionals who have to face individuals who are intoxicated or who have mental health disorders are well aware of this challenge.
The Centers for Disease Control and Prevention defines workplace violence as the act or threat of violence, ranging from verbal abuse to physical assaults directed toward people at work or on duty.1 Furthermore, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) reported that on average, from 2002 to 2013, incidents of workplace violence occurred in health care settings at a rate of more than four times that of private industry.2
In 2016, the Bureau of Labor Statistics reported a total of 16,890 workers were victims of trauma from nonfatal workplace violence.3 Of those workers, 70 percent were employed in health care or social services.3
OSHA updated its “Guidelines for preventing workplace violence for healthcare and social service workers” in 2015.4 In the guide, the authors said, “Health care and social service workers face an increased risk of work-related assaults resulting primarily from violent behavior of their patients, clients, and/or residents.”4 The following organizational risk factors for workers were cited:4
With increased attention to workplace violence—as well as ways to improve processes geared toward supporting and keeping care workers safe—a study published in the February 2019 issue of The Joint Commission Journal on Quality and Patient Safety describes how a large academic hospital designed and tested a huddle handoff communication tool to improve its process for addressing the risk of violent patient events.5
In “Using a potentially aggressive/violent patient huddle to improve health care safety,” Larson and colleagues explain how a multidisciplinary quality improvement (QI) team developed a tool called the Potentially Aggressive/Violent Huddle Form, using two iterative Plan-Do-Study-Act (PDSA) cycles.5
This QI effort came in response to two patient safety incidents during a two-year period in which a patient became violent at the time of admission to the medical unit from the emergency department (ED).5
As part of the communication tool, an ED nurse initiated the huddle process by informing the admitting unit that a patient at risk for violence was being admitted. Then, the admitting care team called the team in the ED to ensure that both teams communicated and participated in the handoff together. The huddle process occurred for 21 transfers in the first PDSA cycle and for 18 transfers in the second.
The results were as follows:
These findings led the study’s authors to conclude that the huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the workplace.5
The Joint Commission recently published a Quick Safety newsletter that focuses on de-escalation techniques in health care. The issue touches on assessment tools to identify aggressive patients, as well as several de-escalation models and ways to defuse aggressive behaviors. The Joint Commission also maintains a web portal for Workplace Violence Prevention Resources for Health Care, including presentations, research and more. Read more about the huddle handoff communication tool in the Journal.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.