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Safety Net: With violence on the rise, otolaryngologists implement prevention strategies

by Richard Quinn • December 1, 2010

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Dr. Bradford takes a sober approach to violence prevention, given her personal history. She recalls one time when an elderly cancer patient of hers sent her a poem that ended with the phrase, “I opened the drawer, pulled out a gun and shot the little snot.” Dr. Bradford was so unnerved she committed the phrase to memory. She called security personnel to investigate, but it turned out to be “just sick humor.”

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Explore This Issue
December 2010

While she has butted against both the threat of violence and actual incidents, Dr. Bradford said she still believes violence is a rare event, and it’s not something she focuses on daily. “I would just call it a heightened awareness,” she added.

Clinic Safety

Cynthia Gregg, MD, FACS, was completing a five-year otolaryngology-head and neck surgery residency at the University of Michigan when Dr. Kemink was shot, and the experience helped shape the private facial and plastic reconstruction clinic she runs in Cary, N.C. It also helped to motivate her in researching and publishing “Violence in the Health Care Environment,” which reported that management of a violent incident includes “early recognition, de-escalation techniques, and a collaborative effort with security personnel” (Arch Otolaryngol Head Neck Surg. 1996;122(1):11-16).

“We used to think of our schools, our hospitals, our libraries as a safe haven,” she says. “That’s not true anymore.”

Dr. Gregg takes a holistic approach to violence prevention, starting with details as seemingly innocuous as a table or chair in the waiting room. Those objects, if they are sharp enough, can be used as a projectile in a violent incident. Her office also has a security system complete with a panic button and silent alarm.

She has instituted code words that her staff can use to alert each other to potential situations and puts yearly reviews in place to keep procedures fresh. All of the techniques and approaches have been implemented as part of basic office operations. “I thought about it when I built the office, and our staff review protocols on an annual basis,” she says. “I don’t think about it on a daily basis.”

In the end, Dr. Schyve preaches vigilance to the dangers of violence but not so much that it overtakes the role of a physician.

Put another way by Dr. Gregg: “There is nothing you can do to completely prevent somebody from entering your office. That’s the nature of our society.”

Preventive Measures

The Joint Commission has issued “suggested actions” that health care organizations can implement to prevent assault, rape and homicide in the health care setting. Those tips include:

  • Working with an institution’s in-house security department to conduct a security audit. The review would analyze protocols and could review historical crime statistics.
  • Surveying employees. What does the staff perceive as risk? One employee may realize a door is left open much of the day, while another doesn’t.
  • Working with human resources up front to establish background check procedures that attempt to weed out potential dangerous actors.
  • Reporting every incident. Threats, perceived risks and other events that stop short of being full-fledged violent acts should be documented and dealt with to help hone how future responses will be handled. That often includes reporting incidents to the police.
  • Being aware of changes in one’s surroundings. Following a familiar refrain in our post-9/11 world, physicians, office managers and back-office staff should be alert to individuals or actions that seem out of the ordinary. Be vigilant, and immediately report suspicions or concerns to a supervisor.
  • Identifying high-risk areas. In a larger institutional setting, that could include hallways that are out of sight. In smaller outpatient clinics, that could mean a waiting room or a back door to the office.
  • Training, training and training. Sessions are available on how to deal with angered family members, frustrated patients and others.

For more information, visit:

  • jointcommission.org/sentinel_event.aspx
  • osha.gov/Publications/osha3148.pdf

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Practice Management Tagged With: patient communication, patient safety, physician safety, practice management, prevention, Security, violenceIssue: December 2010

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