In a national poll conducted this summer by the American College of Emergency Physicians (ACEP), around 85% of emergency physicians reported a rise in ED violence in recent years, which they say has negatively impacted patient care and doctors.

Survey details and key findings

For the survey, Marketing General Incorporated (MGI) on July 25 asked over 30,000 current ACEP members to participate in the poll. After the poll was closed on Aug. 1, a total of 2,712 responses had been completed.

In their report, ACEP compared survey results from 2022 to findings from 2018.

Compared with 2018, a higher percentage of emergency physicians said they were physically assaulted in the ED in 2022 (55%), and a higher percentage said they witnessed the assault of another individual (79%). In addition, fewer emergency physicians said they did not experience or witness an assault in the ED in 2022.

When asked who committed the most recent assault emergency physicians witnessed, respondents indicated that almost all assaults were committed by patients. The findings related to who committed assault did not change significantly from 2018 to 2022. The study found that 98% of assaults were committed by patients in 2022, compared with 97% in 2018.

Emergency physicians reported that psychiatric patients and those seeking drugs or under the influence of drugs or alcohol are most often responsible for the assaults (42% and 40%, respectively).

The most common type of assault emergency physicians encountered in 2022 was verbal assault, with threats of violence, which was reported by 64% of respondents. Meanwhile, 40% of respondents reported hitting or slapping, 31% reported spitting, and 29% reported punching.

Following an assault in the ED, many physicians said they did not receive adequate support from hospitals and law enforcement. Many reported that hospitals' responses to violent events were minimal, with some escorting the perpetrator off the property or restraining them. However, many respondents said the hospital did not take any action. 

According to the poll, the most common response to an assault was putting a behavioral red flag on the patients' charts (29%), followed by arrest (16%).

In 2022, almost nine in ten physicians agreed that violence in the ED harmed patient care (89%)—a figure that has increased significantly since 2018 (77%).

Roughly 85% of physicians said ED violence leads to increased wait times, while 60% said attacks often cause patients to leave the ED before they can receive care. Around 87% of physicians reported a loss of productivity, and 85% reported trauma or increased anxiety as a result of ED violence.

Commentary

Jeremy Faust, an emergency physician at Brigham and Women's Hospital and editor-in-chief of MedPage Today, said there should be harsher penalties for individuals who assault a physician in the ED.

"Emergency physicians and our colleagues don't choose our clients," Faust said. "We treat everyone, anytime, regardless of anything. I think that warrants added protection."

According to Chris Kang, president-elect of ACEP, frustration among patients, lack of access to care, and social isolation may all be contributing to increased violence between patients and hospital staff. "That's impacted the level of trust, and somewhere along the way that also erodes that quality of care that can be provided," he said.

Kang highlighted two pieces of federal legislation introduced in Congress intended to provide added protection to health care workers—the Safety from Violence for Healthcare Employees Act and the Workplace Violence Prevention for Health Care and Social Service Workers Act. However, he noted that hospitals need to track and report incidents and provide additional support to staff.

"Emergency medicine is hemorrhaging," said Alex Skog, president-elect of the Oregon chapter of ACEP. "Now more than ever, I fear that we will lose these frontline medical professionals, unless action to increase the accountability and add protection in emergency departments is addressed with the seriousness and urgency required to stem the tide of violence."

"At this time, given the current measures, given the current support that we have received from various stakeholders, unfortunately we believe this cycle is going to continue to rise," Kang added. "That overall not only affects us physically and emotionally and psychologically, but impacts the care that we need to deliver to you individually, as well as your communities." (D'Ambrosio, MedPage Today, 9/22; ACEP Emergency Department Violence Poll Results, accessed 9/23)