Sharing Best Practices

At New York ENA conferences, attendees have shared best practices and reported using everything from facial recognition software and AI-based weapons detection software, to panic buttons that can be worn or positioned at nursing desks. Nover conceded that many of the tools are expensive (while Dr. Manfredi warned that metal detectors aren’t infallible). Through their Workplace Violence Prevention Alliance, however, the New York ENA and ACEP chapters and collaborating associations have created a toolkit that health care workers can access to review best practices, such as effective anti-violence signage and de-escalation tactics. More EDs are also conducting simulations. “We practice caring for cardiac arrest; we do mock codes. A lot of institutions now are doing mock codes for an aggressive patient or a violent patient,” Nover said.

ACEP continues to embrace initiatives to address the problem, most recently, teaming with a coalition of health care organizations to call on CMS to issue guidance that facilitates posting signage in EDs discouraging violence, and developing a checklist to guide emergency physicians in conversations about violence prevention with colleagues and hospital leaders.

Despite the remaining challenges, several doctors said they’ve seen signs of progress and feel more supported by their workplaces. A few years ago, after a patient took a swing at Dr. Casaletto but missed, her hospital followed up on the ED incident report by offering her counseling and support the next morning, as well as asking whether she wanted to file a police report, needed help in doing so, and needed time off work to recover. Although she didn’t need any help that time, Dr. Casaletto was so surprised that she called back to express her gratitude.

The No Silence on ED Violence campaign, launched in 2019 by ENA and ACEP, is helping to raise awareness and encourage more open discussion about the phenomenon and its potential solutions. For victims of violence, ACEP also has created a peer-to-peer support network, which allows ED physicians to talk with a peer in the aftermath of an incident — support that Dr. Manfredi said she wishes she had received years ago. She said she now believes that ED violence requires a multifactorial, top-to-bottom strategy, including an emphasis on treating people with compassion and kindness. “I think we should try everything,” she said. “I’ve been working with folks in wellness and wellbeing for many years, and we’re not going to give up on it. We’re just going to keep trying different things.”