The Impact of In-Hospital Violence on Critical Care Practitioners: A Growing Crisis!

In-hospital violence (HV) is a growing concern for healthcare facilities around the world, impacting the physical and mental well-being of critical care practitioners. With increasing incidents of violence in healthcare settings, there is an urgent need to address the causes and consequences of such violence and to develop effective prevention and mitigation strategies. The recent study by Bass et al. published in Critical Care Medicine delves into this issue, providing a comprehensive review of hospital violence and its effects on critical care clinicians.

Have you ever experienced or witnessed in-hospital violence by patients or their families in your ICU?

• Never!
• At least once!
• Multiple times..

Understanding In-Hospital Violence:

In-hospital violence is not a new phenomenon, but it has gained increased attention due to its frequency and severity. The authors define hospital violence as an internal disaster that encompasses physical, verbal, sexual, emotional, and psychological harm perpetrated by patients, their families, or even fellow healthcare workers. This violence can be categorized as horizontal (among individuals of the same hierarchical level) or vertical (among individuals at different hierarchical levels).

The study highlights the prevalence of HV in complex care environments, such as intensive care units (ICUs) and emergency departments (EDs), where stress levels are high, and patient interactions are often intense. The risk factors for hospital violence include long ICU stays, conflicts related to treatment decisions, and the influence of social media and online harassment. The COVID-19 pandemic has exacerbated these issues, with increased incidents of interpersonal violence and heightened stress levels among healthcare professionals.

Impact on Critical Care Practitioners:

Hospital violence has profound effects on the physical and mental health of critical care practitioners. The study reveals that HV can lead to physical injuries, fear, anxiety, depression, and burnout syndrome. These consequences not only affect the well-being of clinicians but also compromise patient care and safety. The overlap between hospital violence and workplace discrimination is also significant, as both contribute to negative health outcomes and reduced job satisfaction among healthcare workers.

In a global survey, the authors found that hospital violence is prevalent in both resource-rich and resource-limited settings. In the United States, emergency department physicians reported an increase in assaults from patients and their families, with a rise in both physical and verbal violence. In India, 85% of intensivists experienced hospital violence, with poor communication and billing issues being major triggers. Similar trends were observed in Peru, China, and Australia, highlighting the universal nature of this problem.

Prevention and Mitigation Strategies:

Addressing hospital violence requires a multifaceted approach that involves both individual and systemic interventions. The authors emphasize the importance of conflict management training, communication skill development, and visitor flow and access management practices. Training healthcare workers in de-escalation techniques and providing support for victims of violence are crucial steps in creating a safer work environment.

Regulatory bodies, such as the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), have established standards for workplace violence prevention, requiring hospitals to implement comprehensive programs that include training, risk assessment, and incident reporting. These standards aim to protect both patients and healthcare workers, ensuring a safe and supportive environment for all.

In addition to regulatory measures, the study suggests leveraging technology and data analytics to predict and prevent hospital violence. Machine learning and augmented intelligence approaches can help identify potential perpetrators and assess violence risk, allowing healthcare facilities to implement proactive measures to protect their staff and patients.

Conclusion:

Hospital violence is a pressing issue that demands immediate attention and action from healthcare organizations worldwide. As the study by Bass et al. highlights, the impact of HV on critical care practitioners is significant, affecting their physical and mental health and compromising patient care. By implementing comprehensive prevention and mitigation strategies, healthcare facilities can create safer environments for both clinicians and patients, ultimately improving the quality of care and reducing the burden of hospital violence.

As we move forward, it is essential to continue researching and understanding the complex dynamics of hospital violence and to develop innovative solutions that address the root causes of this growing crisis. By fostering a culture of safety and support, we can empower healthcare professionals to provide the best possible care for their patients while protecting their own well-being.

Reference

1. Bass, Gary A. MD, MSc, MBA, PhD, FEBS EmSurg1; Chang, Cherylee W.J. MD, FACP, FNCS, FCCM2; Winkle, Julie M. MD, FCCM3; Cecconi, Maurizio MD, FRCA, FFICM4; Kudchadkar, Sapna R. MD, PhD, FCCM5; Akuamoah-Boateng, Kwame DNP, ACNP-BC, FCCM6; Einav, Sharon MD, MSc7; Duffy, Caoimhe C. MD8; Hidalgo, Jorge MD, MACP, FCCP, MCCM9; Rodriquez-Vega, Gloria M. MD, FACP, FCCP, FNCS, MCCM10,11; Gandra-d’Almeida, Antonio J. MD, MDM, FACS, FCCM12; Barletta, Jeffrey F. BS, PharmD, FCCM13; Kaplan, Lewis J. MD, FACS, FCCP, FCCM14. In-Hospital Violence and Its Impact on Critical Care Practitioners. Critical Care Medicine 52(7):p 1113-1126, July 2024. | DOI: 10.1097/CCM.0000000000006189