Patient Safety Quartery-ED violence strikes in small communities, too
Emergency department can be a magnet for problem patients
Areas once thought to be safe havens, immune to the violence that plagues "big cities," are now realizing that they also must prepare for the worst and EDs in rural or low-crime areas are increasing their security.
"Everybody is affected by this problem, no matter what community you're in," says Joni Taylor, RN, CEN, director of emergency services at South Coast Medical Center in Laguna Beach, CA. "Relatively speaking, we're a safe community, but I don't think anybody's really immune from violence."
Still, security needs vary depending on your community. "The patient populations of a downtown [Los Angeles] ED vs. one in a little farm community are radically different," says Rob McFarland, a health care safety and security consultant based in Orange County, CA.
As a rule, rural areas need less security, but there are exceptions. "One ED in a farming community in central California had a ferocious problem with drunk and violent patients," recalls McFarland. "There was an extremely high unemployment and welfare rate, which spilled over into the ED, and [people] got violent."
South Coast's ED recently underwent a security assessment when planning a physical redesign with the goal of preventing violence before it occurs. "We now have security doors with a really good controlled access system for separating the waiting room entrance area from the actual ED," Taylor says. "We have the ability to entirely close and contain the ED from the rest of the hospital and the outside."
Cameras allow the registration clerk to observe all waiting areas. "There was initially going to be a solid wall between the main waiting room and an extension waiting room, but we built in windows so our clerks can observe areas of the waiting room that normally wouldn't be visible," she explains.
Establish rapport with police
Establishing a good relationship with law enforcement personnel is essential in small communities. "We have developed a good rapport with local police, so we have immediate assistance when we need it," Taylor says. "As a small community, we've always supported their service and have given them recognition luncheons during the holidays to show our appreciation for them." A prehospital room is available with refreshments for police to do their paperwork.
Police have responded by being extremely responsive to the ED's needs. "Often, when patients are brought in by police for evaluation and we're not sure what the disposition will be, they will need close observation in the meantime," says Taylor. "While we're treating other people with life-threatening emergencies, those patients can be very disruptive or walk out and disrupt the community. The local police have been very supportive of us by staying in the department when we needed them to."
Many EDs in relatively low-crime areas are keenly aware of the potential for violence. That point was brought home at South Coast when one of the ED's patients went on a shooting spree locally. "He easily could have come in here, and that was the kind of situation we took into consideration when we planned for our new ED," Taylor says. "We need to protect our staff and patients the best way possible, without going overboard with bulletproof glass and metal detectors — there is a limit."
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