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Protection from Violence in the Emergency Department
Policy Statements
Availability expenses. The emergency department must be appropriately staffed and operational 24 hours a day, 7 days a week whether any patients are present or not. Unlike other specialists who can be “on call,” emergency physicians must be physically present and ready to provide care at all times. This unique practice requirement incurs significant costs that cannot be allocated to a particular patient. Costs associated with the preparation for and participation in planning for regional and national disasters, including travel and lodging, vaccine and immunization updates, shift coverage, community support, and adherence to federal and state mandates. Expenses related to the support and adherence to mandated performance and quality measures required by hospital and regulatory agencies and third-party payers. Expenses related to compliance with mandated patient satisfaction initiatives. Administrative costs required for adherence to compliance regulations, eg, patient privacy issues. Approved April 2016 Revised and approved by the ACEP Board of Directors April 2016, June 2009 Reaffirmed by the ACEP Board of Directors June 2002 Revised and approved by the ACEP Board of Directors June 1997, September 1992 Originally approved by the ACEP Board of Directors June 1987 http://dx.doi.org/10.1016/j.annemergmed.2016.06.035
Protection from Violence in the Emergency Department [Ann Emerg Med. 2016;68:403-404.] The American College of Emergency Physicians (ACEP) believes that workplace violence is a preventable and significant public health problem and that optimal patient care can be achieved only when patients, health care workers, and all other persons in the emergency department (ED) are protected against violent acts occurring within the department. As such, ACEP advocates increased awareness of violence against health care workers in the ED and increased safety measures in all EDs. Furthermore, ACEP encourages all states to enact legislation that provides a maximum category of offense and criminal penalty against individuals who commit violence against health care workers in the ED. Volume 68, no. 3 : September 2016
To ensure the safety and security of the ED environment, the hospital and its administrators have the following responsibilities: Provide an ED security system based on institutionspecific risk assessment that includes adequate security personnel, sufficient training of personnel, physical barriers, surveillance equipment, and other security components. Conduct ongoing assessments of the ED security system performance. Coordinate the hospital security system with local law enforcement agencies. Develop written ED protocols with input from employees for violent situations occurring in the ED to ensure the safety of patients, visitors, and health care workers alike. Educate staff through formal, regular training on early recognition of individuals with potential to become violent, techniques for de-escalation, nonviolent crisis intervention, and importance of seeking assistance. Develop and enforce a mandatory reporting policy that requires employees to promptly report any verbal or physical assault. Such policies should clearly state that reporting will not result in any adverse action by the hospital such as termination, threatening to terminate, demoting, suspending, or in any manner discriminating against an employee who reports an assault. Adopt a zero-tolerance policy for employees, patients, and visitors that states that any violence in the ED is not acceptable. Educate employees that any assault is not considered “part of the job.” Provide appropriate postincident support for employees involved in violent events, including prompt medical treatment, debriefing, counseling, and employee assistance. Pursue maximum criminal prosecution, when deemed appropriate, against those individuals who commit violent acts against health care workers. Additionally, ACEP recognizes that the emergency medical services (EMS) system is an integral component of emergency care and supports and encourages efforts to protect EMS personnel against physical violence in the out-of-hospital environment. Approved April 2016 Revised and approved by the ACEP Board of Directors with new title “Protection from Violence in the Emergency Department” April 2016 Revised and approved by the ACEP Board of Directors June 2011 Annals of Emergency Medicine 403
Policy Statements
Revised and approved by the ACEP Board of Directors with new title “Protection from Physical Violence in the Emergency Department Environment” April 2008 Reaffirmed by the ACEP Board of Directors October 2001 and October 1997 Originally approved by the ACEP Board of Directors with title “Protection from Physical Violence in the Emergency Department” January 1993 http://dx.doi.org/10.1016/j.annemergmed.2016.06.036
CME Burden [Ann Emerg Med. 2016;68:404.] Continuing medical education (CME) is required for maintenance of board certification by the American Board of Emergency Medicine and the American Osteopathic Board of Emergency Medicine. The American College of Emergency Physicians (ACEP) believes that continuous board certification demonstrates comprehensive training, skills, and current understanding in the practice of emergency medicine. CME course work is increasingly being mandated for licensure, certification, and privileging by states, regulatory agencies, and hospitals. Some examples include CME for stroke center certification, trauma center certification, and sedation privileges, among many others. Emergency physicians practice in a variety of emergency department settings and care for patients with a wide range of conditions. The aforementioned educational courses have value, but by requiring a significant and increasing number of these CME courses, physicians may have reduced education time to remain current in other clinical areas more relevant to their practice in emergency medicine. Therefore, ACEP, in supporting high-quality, safe, and efficient emergency care for all patients, believes that CME requirements as a part of maintenance of board certification should be self-determined by the specialty organization and by practicing emergency physicians to reflect their practice environments. Peer-identified educational opportunities may also supplement an individual practitioner’s CME choices. This will have a greater benefit than the imposition of general CME requirements. Approved April 2016 Approved by the ACEP Board of Directors April 2016 http://dx.doi.org/10.1016/j.annemergmed.2016.06.037
404 Annals of Emergency Medicine
Quality Improvement Initiatives for the Care of Geriatric Patients in the Emergency Department [Ann Emerg Med. 2016;68:404.] The American College of Emergency Physicians (ACEP) recognizes that the care of geriatric patients provides both unique challenges and opportunities for improvement in outcomes and patient experience. ACEP supports the continued development of quality improvement initiatives for the care of geriatric patients in the emergency department (ED). Some general categories and potential indicators of quality in the care of elderly patients, as outlined in the Geriatric Emergency Department Guidelines,1 include but are not limited to the following: Clinical B Optimal patient outcomes B Pain management B Geriatric-focused screening tools B Integration of geriatric psychiatry Operational B Admission/readmission rates B ICU admission rates B Use of observation units B Length of stay in acute care setting Safety B Falls B Iatrogenic complications B Medication appropriateness, interactions, errors (including polypharmacy) Care management B Transitions of care B Discharge planning B Outpatient follow-up B Home health services, hospice, and palliative medicine B Caregiver (eg, family, power of attorney) support Structural B ED staffing and expertise B Physical environment Approved April 2016 Approved by the ACEP Board of Directors April 2016 REFERENCE 1. Geriatric Emergency Department Guidelines; Joint Statement by the American College of Emergency Physicians, American Geriatric Society, Emergency Nurses Association, and Society for Academic Emergency Medicine, 2013. http://dx.doi.org/10.1016/j.annemergmed.2016.06.038
Volume 68, no. 3 : September 2016
Availability expenses. The emergency department must be appropriately staffed and operational 24 hours a day, 7 days a week whether any patients are present or not. Unlike other specialists who can be “on call,” emergency physicians must be physically present and ready to provide care at all times. This unique practice requirement incurs significant costs that cannot be allocated to a particular patient. Costs associated with the preparation for and participation in planning for regional and national disasters, including travel and lodging, vaccine and immunization updates, shift coverage, community support, and adherence to federal and state mandates. Expenses related to the support and adherence to mandated performance and quality measures required by hospital and regulatory agencies and third-party payers. Expenses related to compliance with mandated patient satisfaction initiatives. Administrative costs required for adherence to compliance regulations, eg, patient privacy issues. Approved April 2016 Revised and approved by the ACEP Board of Directors April 2016, June 2009 Reaffirmed by the ACEP Board of Directors June 2002 Revised and approved by the ACEP Board of Directors June 1997, September 1992 Originally approved by the ACEP Board of Directors June 1987 http://dx.doi.org/10.1016/j.annemergmed.2016.06.035
Protection from Violence in the Emergency Department [Ann Emerg Med. 2016;68:403-404.] The American College of Emergency Physicians (ACEP) believes that workplace violence is a preventable and significant public health problem and that optimal patient care can be achieved only when patients, health care workers, and all other persons in the emergency department (ED) are protected against violent acts occurring within the department. As such, ACEP advocates increased awareness of violence against health care workers in the ED and increased safety measures in all EDs. Furthermore, ACEP encourages all states to enact legislation that provides a maximum category of offense and criminal penalty against individuals who commit violence against health care workers in the ED. Volume 68, no. 3 : September 2016
To ensure the safety and security of the ED environment, the hospital and its administrators have the following responsibilities: Provide an ED security system based on institutionspecific risk assessment that includes adequate security personnel, sufficient training of personnel, physical barriers, surveillance equipment, and other security components. Conduct ongoing assessments of the ED security system performance. Coordinate the hospital security system with local law enforcement agencies. Develop written ED protocols with input from employees for violent situations occurring in the ED to ensure the safety of patients, visitors, and health care workers alike. Educate staff through formal, regular training on early recognition of individuals with potential to become violent, techniques for de-escalation, nonviolent crisis intervention, and importance of seeking assistance. Develop and enforce a mandatory reporting policy that requires employees to promptly report any verbal or physical assault. Such policies should clearly state that reporting will not result in any adverse action by the hospital such as termination, threatening to terminate, demoting, suspending, or in any manner discriminating against an employee who reports an assault. Adopt a zero-tolerance policy for employees, patients, and visitors that states that any violence in the ED is not acceptable. Educate employees that any assault is not considered “part of the job.” Provide appropriate postincident support for employees involved in violent events, including prompt medical treatment, debriefing, counseling, and employee assistance. Pursue maximum criminal prosecution, when deemed appropriate, against those individuals who commit violent acts against health care workers. Additionally, ACEP recognizes that the emergency medical services (EMS) system is an integral component of emergency care and supports and encourages efforts to protect EMS personnel against physical violence in the out-of-hospital environment. Approved April 2016 Revised and approved by the ACEP Board of Directors with new title “Protection from Violence in the Emergency Department” April 2016 Revised and approved by the ACEP Board of Directors June 2011 Annals of Emergency Medicine 403
Policy Statements
Revised and approved by the ACEP Board of Directors with new title “Protection from Physical Violence in the Emergency Department Environment” April 2008 Reaffirmed by the ACEP Board of Directors October 2001 and October 1997 Originally approved by the ACEP Board of Directors with title “Protection from Physical Violence in the Emergency Department” January 1993 http://dx.doi.org/10.1016/j.annemergmed.2016.06.036
CME Burden [Ann Emerg Med. 2016;68:404.] Continuing medical education (CME) is required for maintenance of board certification by the American Board of Emergency Medicine and the American Osteopathic Board of Emergency Medicine. The American College of Emergency Physicians (ACEP) believes that continuous board certification demonstrates comprehensive training, skills, and current understanding in the practice of emergency medicine. CME course work is increasingly being mandated for licensure, certification, and privileging by states, regulatory agencies, and hospitals. Some examples include CME for stroke center certification, trauma center certification, and sedation privileges, among many others. Emergency physicians practice in a variety of emergency department settings and care for patients with a wide range of conditions. The aforementioned educational courses have value, but by requiring a significant and increasing number of these CME courses, physicians may have reduced education time to remain current in other clinical areas more relevant to their practice in emergency medicine. Therefore, ACEP, in supporting high-quality, safe, and efficient emergency care for all patients, believes that CME requirements as a part of maintenance of board certification should be self-determined by the specialty organization and by practicing emergency physicians to reflect their practice environments. Peer-identified educational opportunities may also supplement an individual practitioner’s CME choices. This will have a greater benefit than the imposition of general CME requirements. Approved April 2016 Approved by the ACEP Board of Directors April 2016 http://dx.doi.org/10.1016/j.annemergmed.2016.06.037
404 Annals of Emergency Medicine
Quality Improvement Initiatives for the Care of Geriatric Patients in the Emergency Department [Ann Emerg Med. 2016;68:404.] The American College of Emergency Physicians (ACEP) recognizes that the care of geriatric patients provides both unique challenges and opportunities for improvement in outcomes and patient experience. ACEP supports the continued development of quality improvement initiatives for the care of geriatric patients in the emergency department (ED). Some general categories and potential indicators of quality in the care of elderly patients, as outlined in the Geriatric Emergency Department Guidelines,1 include but are not limited to the following: Clinical B Optimal patient outcomes B Pain management B Geriatric-focused screening tools B Integration of geriatric psychiatry Operational B Admission/readmission rates B ICU admission rates B Use of observation units B Length of stay in acute care setting Safety B Falls B Iatrogenic complications B Medication appropriateness, interactions, errors (including polypharmacy) Care management B Transitions of care B Discharge planning B Outpatient follow-up B Home health services, hospice, and palliative medicine B Caregiver (eg, family, power of attorney) support Structural B ED staffing and expertise B Physical environment Approved April 2016 Approved by the ACEP Board of Directors April 2016 REFERENCE 1. Geriatric Emergency Department Guidelines; Joint Statement by the American College of Emergency Physicians, American Geriatric Society, Emergency Nurses Association, and Society for Academic Emergency Medicine, 2013. http://dx.doi.org/10.1016/j.annemergmed.2016.06.038
Volume 68, no. 3 : September 2016