Background: Physical assaults by patients on emergency department (ED) staff are on the rise despite efforts to train ED physicians on managing agitation such as the BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines. Our residency leadership created BETA centered initiatives to reduce ED violence, which included dedicated de-escalation training, lectures, simulation, and an “agitation” order set in the electronic medical record. We hypothesized that these initiatives would decrease physical assaults on our residents.
Methods: This is a before and after study using SurveyMonkey on our residents in December 2015 to determine the incidence of physical assaults by agitated patients in a large county hospital ED during their residency training before these initiatives were implemented and in December 2018, after these initiatives were implemented, to determine the incidence of physical assaults during a 6-month period prior to the survey. Descriptive statistics were used to analyze the data.
Results: In the before survey in 2015, 60.6% (40/66) of residents responded: 34.1% PGY1, 36.6% PGY2 and 29.3% PGY3 residents. Of these, 22.5% (9/40) reported they had been physically assaulted, some more than once. In the 2018 after survey, 80.3% (53/66) of residents responded: 34.0% PGY1, 34.0% PGY2 and 32.1% PGY3 residents. Of these, 11.3% (6/53) reported being physically assaulted. Three of these assaults were by agitated jail or psychiatric patients and the residents commented that they could have been prevented by earlier use of medications to decrease agitation and police involvement. One assault was by a confused elderly patient. One assault was accidental by a non-agitated patient. An item was thrown but missed the resident in one incident.
Conclusion: Incorporation of the BETA guidelines into an order set and residency training can reduce the number of physical assaults. Earlier use of medications and police can also reduce these assaults form occurring. The numbers reported may be an underestimation of the total number of assaults in both surveys. In the before survey, the response rate was lower and several residents reported that they were assaulted more than once but the exact number of times and details of each assault were not determined in the survey . The after survey was only conducted over a 6 month period but is a more accurate survey.