Background: Over two-thirds of workplace assaults in the United States occur in healthcare and social services settings. Patients/visitors are the most common source of workplace violence (WPV), called type II WPV. Nurses, clinicians working in the emergency room, behavioral and psychiatry wards are at high risk for type II WPV. National and international organizations recommend multimodal strategies and de-escalation training for high-risk healthcare workers to reduce WPV. There is little data about prevalence of type II WPV and the impact of de-escalation training among the hospitalists.
Methods: All hospitalists at an academic urban medical center in Baltimore who participated in a mandatory institution sponsored 3-hour in person de-escalation training were eligible to participate in this study. The training sought to teach participants the skills to recognize signs of potential aggression from patients, de-escalation techniques and self-defense skills using role playing and didactics. The prevalence of type II violence was measured using a WPV questionnaire, adapted from the survey developed by the World Health Organization, and asked questions about exposure to physical violence, verbal abuse, sexual harassment, and racial abuse in the 12 months prior to de-escalation training. The effects of de-escalation training were studied by measuring clinician’s self-reported “Confidence in Coping with Patient Aggression” using a validated scale developed by Thackrey. It is a unidimensional instrument which uses 10 items with an 11-point Likert type scale from 1 (low confidence) to 11 (high confidence). Total score can range from 10 to 110. The instrument was administered pre-training, immediately after training, at 3 months, 6 months and after 12 months.
Results: Of 37 participants, 59.5% were physicians, 56.8% were female, 37.8% identified as non-white with a median experience of 7 years. Of all participants, 86.5% reported at least one form of WPV by patients or visitors. The majority (83.8%) reported experiencing verbal abuse, 18.9% physical violence, 16.2% sexual harassment and 29.7% racial abuse. Mean ‘confidence in coping with aggressive patients’ score increased significantly from pre-training (43.2) to immediately after the training (68.5) and remained significantly elevated at 3 months (57.2), at 6 months (60.2), and after 12 months (59.9) (all p < 0.05) with Ptrend = 0.017.
Conclusions: This study reveals hospitalists experience high levels of WPV from patients/visitors and de-escalation training may empower hospitalists to cope with aggressive patients. Future research and policy changes should prioritize the urgent need to develop strategies to recognize and prevent WPV faced by hospitalists.