Q: I read often about patient safety – but what about physician safety?
A: The ProAssurance Risk Resource has fielded several calls about violent patients, including one who carried a handgun. You may recall that last summer The Joint Commission released a report regarding violence in hospitals that you can access here.
The face of health care delivery is changing and collaborations between physician practices and hospitals are ever-increasing, giving greater importance to awareness of potential violence in the hospital setting.
The Joint Commission’s report stated there have been 256 reports of violent crimes since 1995, yet experts believe many instances go unreported. And though most cases of violence happen in the emergency department, the potential exists system-wide.
Many factors can contribute to violence in the health care setting – an angry patient or family member, an intoxicated/impaired patient, an anxious patient who feels out of control, a patient in great pain, to name a few.
Aside from assessing an institution’s workplace safety policies, these tips from ECRI Institute may be of assistance:
- Ensure security personnel is available
- Relocate other patients as necessary
- Encourage employees and other staff to report incidents of violence
- Train appropriate staff to respond to violence and consider counseling programs for employees who are victims of violence in the workplace
The Medical College of Georgia’s Violence in the ED Manual includes these recommendations:
- Ensure there is a door nearby for exit/escape
- Refrain from approaching a patient from the rear
- Maintain a safe distance and do not run or fight unless ensured of success
If violence, whether physical or verbal, is ongoing with a particular patient, consider terminating that patient from your practice. To minimize liability risk, attempt to discuss the termination and your reasons with the patient.
Follow that by sending the patient, with 30 days notice (as recommended by the AMA), written confirmation of the termination via regular mail and certified mail with return-receipt requested.
The letter should include a reminder that the patient’s condition requires care and suggest the patient find a new physician immediately. Include contact information for a medical referral service, if applicable, and advise how a patient may obtain a copy of the medical records. Personally sign the letter and place a copy in the patient’s chart.
Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via email.