Four in five staffers from emergency departments (EDs) in various Beirut hospitals have been verbally abused, and a quarter of them have been physically assaulted by distressed patients and their families over the past year, according to a new AUB study.
Conducted by Mohamad Alameddine, an assistant professor at the Department of Health Management and Policy, and Amine Kazzi, an associate professor at the Department of Emergency Medicine, the study systematically investigated the level, characteristics, and consequences of violence against ED workers in six Lebanese hospitals.
More than a third of the documented assaults had resulted in physical injury, according to the study which was supported by a grant from AUB's University Research Board.
The results of the 2009 study have alarmed hospital administrators and researchers who also demonstrated that such violence could spur high staff turnover rates at the emergency departments.
The study showed that 35 percent of ED workers intend to leave their jobs over the next three years, and an additional 20 percent are undecided about whether to stay or leave. "These findings are alarming. If we do not act fast, there will be a considerable turnover of ED employees. There is a significant association between exposure to violence and the intention to quit," said Alameddine.
After surveying 256 emergency department workers from Beirut hospitals, the study collected information on demographic characteristics, professional background, exposure to violence, professional burnout, and satisfaction with the work environment.
Workers included attending physicians, postgraduate trainees, nurses, administrative personnel and security guards.
"Amongst providers, attending physicians had the highest rate of exposure to verbal abuse (88 percent); nurses were the most exposed to physical violence (34.6 percent). From those workers who were physically assaulted, 40 percent reported either being grabbed, kicked, or punched, and 16 percent reported being threatened by a knife or gun," said Alameddine.
"Decision- and policy-makers must push for a violence-free work environment. This cannot be achieved only through zero tolerance towards perpetrators of violence, but also through a root cause analysis to reduce, if not eliminate, the reasons behind such a deplorable work environment. Current conditions must not be tolerated as they interfere with and cause unacceptable emergency service delivery to distressed and sick members of our communities," said Dr. Kazzi.
The perpetrators of violence are patients' family members and/or friends in more than two-thirds of incidents with examination and waiting areas reported as the most common locations for violence. The most cited factors leading to violence consist of: waiting times in the emergency departments (77.8 percent), family expectations (50.4 percent), staff attitude (38.3 percent), lack of effective anti-violence policies (34.4 percent), and inadequate resources (19 percent).
"All stakeholders must not miss or disregard the various deep-rooted reasons and precipitants for such outbursts and behavior: perceived or actual restricted or lack of access, poor service delivery or professionalism, poor levels of support and practice conditions," noted Kazzi. "Any mismatch ... between patient needs and available resources causes friction and could escalate—is escalating—on a daily basis into aggression and verbal abuse and frequently into physical violence."
Only one-third of surveyed employees have confirmed the presence of anti-violence policies in their institutions. The remaining two-thirds either indicated the absence of such policies or their unawareness of them. Only a quarter of emergency department employees confirmed that ED policies, if existent, were being implemented.
According to Alameddine and Kazzi, the findings will be presented at the International Conference of Violence in Health Care in Amsterdam this coming October, where international experts will discuss hospital violence and advise on how to protect staff.
The preliminary analysis suggests that violence, especially verbal abuse, is a prevailing aspect of the work environment in surveyed emergency department workers and that some of the factors that instigate violence, such as wait times, staff attitude, and lack of resources, can be amenable to the intervention of the administration and management of EDs.
