Hospital EDs are taking a proactive approach to violence
By Eric Wicklund
The Emergency Department is a hectic environment, requiring clinicians to be ready for almost anything. That shouldn’t, however, include violence.
With roughly 85% of emergency physicians reporting in a recent survey that ED violence has increased over the past five years, health systems are taking action to protect both providers and patients. And while the most visible response is to increase security in the ED, some are using technology to take a more proactive approach.
At Sturdy Memorial Hospital in Attleboro, Massachusetts, administrators are tapping into the electronic health record platform to identify ED patients with a history of threatening behavior, which pushes out alerts to the care team. Those alerts not only give providers advance warning, but can help them call in behavioral healthcare specialists to help those patients.
“It’s definitely led to a lot more awareness,” says Brian Patel, MD, the hospital’s senior vice president of medical affairs and chief medical officer. “There are a lot of different reasons [that lead to stressful or violent situations in the ED.] If we can improve communication and get ahead of this, we are creating opportunities to improve both safety and care.”
To get the most out of its EHR, Sturdy Memorial is working with digital health company Collective Medical, a business unit of PointClickCare. The hospital began working with Collective Medical in 2017 on ED utilization, and integrated security and care guidelines in 2021.
Once considered more of a hindrance than a help in improving clinical care, EHR platforms are slowly becoming more valuable in the hospital as vendors fine-tune the complex technology and providers learn how to use them. Among the bigger benefits just now being realized is the EHR’s ability, under the right circumstances, to capture the entire patient history, collecting not only clinical information but data on social determinants of health, or outside factors that affect healthcare access and outcomes.
That includes behavioral or societal clues that could indicate a combative patient, such as past run-ins with the law, treatment for stress or aggressive behavior, or other clues that could indicate the patient is confused or agitated. An ED doctor or nurse seeing those clues in the EHR could then not only alert the hospital’s security personnel, but call in specially trained care providers or social workers to work with the patient.
“There’s so much information out there that could be useful,” Patel says, “but in the past a lot of it was fragmented.” In many cases, ED care teams were forced to piece together past reports or self-reported data, then an educated guess as to whether to take precautions.
Aside from reducing violence in the ED, the platform also improves care coordination and management by bringing in behavioral health resources more quickly to treat a patient. This ensures that a patient is connected more quickly to the right care providers and isn’t forced to wait for a long time in the ED—an additional source of stress and agitation.
“The impact of the ED case manager program and our work with PointClickCare for patients with behavioral health challenges has been substantial, even during the pandemic, when behavioral health needs have increased, and staff resources have been stretched thin,” Patel said in a separate e-mail to HealthLeaders. “Today, unnecessary ED utilization by individuals with mental health challenges managed through this program remains 44% lower than the six-month period prior to entering the program. And, because of the social determinants of health component of patient assessment, individuals not only receive better care, but also connections with resources that help meet their whole health needs, from healthy food to transportation to appointments or safe shelter.”
There are, of course, challenges to using the technology. Patel says the platform was initially intended to reduce bias by giving providers as much objective information as possible so that they didn’t have to make a decision solely based on how a patient looks or acts. But technology can introduce bias as well, and providers are cautioned to not jump to conclusions.
“This has to be treated very carefully,” he says. “We have to avoid labeling patients. And that comes with learning how to use the technology correctly. We’re all getting much more [comfortable] with the technology, but we have to avoid asking too much of it. The system is only as good as what we put into it.”
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.