ED Resident Physicians at High Risk of Workplace Violence Incidents

June 29th, 2021

By Jill Drachenberg, Editor, Relias Media

Emergency physicians, residents, nurses, and other staff work in tense, high-stakes situations with patients and their families. A new analysis in the Annals of Emergency Medicine revealed resident ED physicians are at particularly high risk of experiencing verbal or physical assault.

Investigators surveyed 123 healthcare worker (HCWs) in one ED. Seventy-eight percent of HCWs reported experiencing a violent encounter in the previous 12 months, and 80% experienced verbal assaults. However, 22% of resident physicians reported violent encounters, and 89% experienced verbal assaults.

A resident’s risk of experiencing violence increases with time spent in the program, investigators found. Among first-year residents, 62% experienced verbal assault, and none reported physical violence. All second- and third-year residents reported verbal assault. Physical assaults were experienced by 25% of second-year residents and 36% of third-year residents.

Investigators also found residents and other staff were reluctant to report such events. Only 20% of respondents filed physical assault complaints with hospital leadership or law enforcement. None of the residents reported physical assaults.

"Violent or threatening incidents in the emergency department pose risks to everyone's safety but can also impact health workers' mental health and may increase the likelihood of burnout," Lauren Querin, MD, MS, lead author and emergency physician with the University of North Carolina Chapel Hill Department of Emergency Medicine, said in a statement. "These encounters happen frequently and often go unreported."

Long accepted as simply part of the job, more hospitals and organizations are recognizing the need to enact stronger workplace violence prevention policies.

“As clinicians are well aware, workplace violence traditionally has been underreported and seen mistakenly by some as part of the job of dealing with patients. No more,” says Gary Evans, medical writer for Hospital Employee Health. “In the sweeping re-evaluation of the healthcare system that is coming amid the COVID-19 pandemic, protecting valuable healthcare workers from patient attacks seems like an idea whose time has finally come.”

For example, The Joint Commission (TJC) recently published updated workplace violence prevention standards for all its accredited hospitals. The updated standards define workplace violence as “An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.”

“Exposure to workplace violence can impair effective patient care and lead to psychological distress, job dissatisfaction, absenteeism, high turnover, and higher costs,” TJC stated. “The high incidence of workplace violence prompted the creation of new accreditation requirements.”