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I was a victim of violence in the E.D. Here's my story. Pt. 1

Posted on Wed, Aug 06, 2014
I was a victim of violence in the E.D. Here's my story. Pt. 1

According to a survey by the International Association for [DeniseSexton photo] Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within emergency departments to reduce acts of violence in the hospital.

By Denise Sexton, RN, BSN, Divisional Director of Clinical Services, EmCare

Working in the emergency department can go from boring to over the top in just a few seconds. That is what draws most people to emergency medicine. Emergency departments care for everyone that comes through the doors — from patients with a simple toothache to patients with level 1 trauma. With the decrease in mental health facilities and inpatient psychiatric units, we also get psychiatric patients. These patients can be very unpredictable. They can range from the mildly depressed to the acutely psychotic patient who can break out of 4-point restraints.

The police frequently bring patients to the emergency department for clearance before they can take them to jail. In many cities, anyone in custody who appears to be even mildly depressed or suicidal gets brought in for evaluation by the emergency department physicians.

The facility where I worked had an inpatient adult psychiatric unit. So, a majority of the patients we treated were psychiatric patients. On one particular occasion, a patient was brought in by the local EMS. This person was not much bigger than me. The patient was feeling mildly suicidal. I triaged and assessed the patient in the room. Everything was fine. I told him that he would have to get undressed, his personal belongings would be searched and removed from the room, labs would be drawn, and then when the results were back and he was medically cleared, the mental health clinician would be in to evaluate him. This generally took about 2-3 hours. He was very cooperative, got undressed and into his gown and was searched. At that point, I went to the nurses’ station to do my charting. The security guard was with the patient and the lab tech went in to draw blood.

In a split second, the patient jumped out of bed. He punched out the security guard and ran into the hallway. Our healthcare tech, who was much larger than the patient, tried to stop him and got thrown to the ground and punched. The patient then ran into another patient’s room and punched a family member. I was standing in front of the exit door and saw the patient running towards me. I knew by the look in his eyes that he had completely lost it. I stepped aside and decided to let him run out the door. I figured he would be easy to find in only a hospital gown. He looked at me when I stepped aside and said “and you too.” And, wham! He hit me in the face. I looked at the video footage later and saw myself fly about 5 feet across the floor. After the hit, I curled up in hopes that he did not hit me anymore.

He ran out the door and was apprehended a short while later by the police. While all of this was happening, the staff hit the panic button which alerted all the police in the area and called a code in the hospital so all the hospital staff came running. All of this happened in less than 2 minutes.

The hospital was very supportive of all of us during and after this. The patient had to be brought back to our facility for treatment and evaluation, but was transferred to the state facility fairly quickly. Everyone was on guard when he came back. I never knew what happened to the patient after that, but I know he was facing multiple charges.

Was there anything that could have been done differently? I have asked myself that many times. I always come up with the same answer “No.” I have taken care of hundreds of psych patients and this patient gave no indication that he was going to act out like he did. None of us saw this type of behavior coming. When we performed the Root Cause Analysis of the incident, we all agreed that the behavior was not expected from this individual and we have no idea what pushed him over the edge.

ABOUT THE AUTHOR

Denise Sexton offers 20 years of healthcare experience to EmCare partner hospitals, and over 15 years specifically in the emergency department and in leadership roles. As a Divisional Director of Clinical Services for EmCare, Denise’s strength in leadership and diverse clinical skills provides a solid foundation for improving hospital operations, not only in the E.D, but also with services including hospitalist programs, observation units, operating rooms and critical care units. Denise uses her education and experience to offer expertise and broad perspectives for E.D. and inpatient managers.

Do you have a story of violence in your ED? What steps has your hospital taken to prevent violence? Tell us in the comments. Next week: In part 2 of this 3-part series, Ginger Wirth shares her experience with violence in the ED.

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