Last year one of my patients was on the phone, lamenting about how long he had been in the emergency room. He had already waited several hours to get a CT scan. Medications he was supposed to be given were repeatedly delayed. I heard his voice rise and fall, with each swell more expansive than the one before. When I turned to look at him, he yelled a racial epithet before hurling a desktop computer into the area where doctors and nurses sit. A seasoned nurse ducked. As I pushed an intern and medical student out of the way, he charged at us with a steel tray. Thankfully, no one was injured.

According to the article, a 2022 survey of Emergency Medicine Physicians found that “55 percent said they had been physically assaulted, almost all by patients, with a third of those resulting in injuries. Eighty-five percent had been seriously threatened by patients.” For ER nurses, it is worse: 70% reported physical assaults at work.

This is unconscionable.

The article was written by Emergency Medicine physician and Columbia University professor Dr. Helen Ouyang. She wrote this:

In the E.R., there’s a certain level of resignation that violence is just part of the job, like getting bloodstains on our shoes. We have come to endure racist, sexist and homophobic slurs, choosing silence over confrontation, to fulfill our duty to care for human life. After all, we pledge to hold our patients’ well-being above all else.

Violence should never, ever, ever, ever, ever be “just part of the job.” This is unacceptable. Those of us who have answered the call of healthcare – whether physician, or nurse, or respiratory therapist, or physical therapist, or patient care technician – have sacrificed a great deal to be here. We have given so much of our time, our blood, our sweat, and our tears to care for those who are ill.

No part of this job should include violence directed toward the healthcare team. None.

I understand that sometimes, if not many times, patients are not in their right minds. They may be sick with infection, or organ failure, or substance abuse. That does not excuse violence against us. I always say that patient safety is “number one a.” Staff safety is “one b”: it is co-equal with patient safety.

We can’t easily fix the societal maladies that lead to violence against healthcare workers. At the same time, every healthcare institution must ensure that their staff is safe at work. It is an absolute necessity.

Please make sure you read the article and watch the opinion video accompanying it. It is heart-wrenching.

And I say again: violence should never, ever, ever, ever be “just part of the job.” It is absolutely unacceptable.

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AI video monitoring systems offer hospitals a powerful tool to observe patients constantly, even when a staff member is not in the room. The AI watches the video, extracts movement patterns, and can identify key actions to understand trends and moments. Then, by creating workflows using this information, hospitals can improve what they know about their patients, reduce staff pressure on what happened when they were not in the room and enhance overall efficiency.

By continuously monitoring patients, these systems can become a trusted part of the bedside team – reducing clinician anxiety from the unknown of what is happening with one patient while occupied with others.

Observe, Recognize and Act: The Power of Human + AI in Patient Safety

Upon examining ECRI’s safety concerns, three core themes emerge timely intervention, adequate clinical support, and efficient care coordination. The absence of these aspects can compromise patient safety, leading to inadequate care and potential harm. In this respect, AI has a crucial role to play by aiding healthcare providers in time-critical decision-making. This kind of AI, augmented by virtual providers to support the bedside team, can improve efficiency and serve as a guardian angel for patients and their teams.

Combating Violence Against Healthcare Staff

AI’s ability to instantly identify aggression towards healthcare staff via video monitoring and predictive analysis can mitigate and diffuse potential safety issues before they escalate. In addition, by tracking how a patient is moving over time and changes in their patterns, video monitoring can help identify patients whose risk levels have risen. Combined with low-cost, ubiquitous video, providers can check in virtually anytime –  providing quicker responses to patients and reducing the potential for hazardous interactions.

Virtual Provider as the Guardian Angel of the Bedside Team

Often, clinicians are thrust into work beyond their competencies or scope of practice –  a situation that leads to professional burnout and dissatisfaction. This is particularly acute with nursing shortages that have led to less experienced nurses being put into more difficult situations than previous generations.

A virtual nursing system powered by AI could provide much-needed assistance, especially when nurses have to adapt to different unit requirements. A virtual nurse can offer real-time assistance regarding medication information or mentoring for specific procedures or other unit-specific details. By empowering the virtual nurse with AI that watches all patients, a more experienced virtual nurse can be directed to patients facing more precarious situations – like a static patient in bed who has not had a care in the last two hours (increasing their risk for pressure injury).

Also, virtual nurses can act as a secondary verification mechanism, reducing the possibility of medication errors directly related to three of the top ten safety concerns.

Optimizing Care Coordination

Gaps in care coordination for patients with complex medical conditions can have serious consequences. The attention to detail needed typically guides such patients to ICU settings. However, it is becoming more common that patients in step-down units have similar characteristics but with a fraction of the attention.

Continuous AI video monitoring can track a patient’s movement, location, care activity and related trends, making it more straightforward to monitor patients transitioning from higher acuity settings more closely virtually. This enhanced monitoring, paired with simplified virtual consultations, creates better care coordination between the teams where the patient is and where they came from. Similarly, it helps to ensure that critical care is not omitted from the patient’s journey.

Conclusion

Navigating patient safety concerns in today’s healthcare landscape is a daunting task. But with the integration of AI and human expertise, we can confidently address these challenges. AI not only enhances patient safety and care quality, but it also alleviates the burden on healthcare staff, improving their work lives. As the healthcare industry evolves, adopting AI will be instrumental in overcoming patient safety challenges and achieving optimal care outcomes.

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A nurse was killed when she refused to give a patient a cigarette. Of course, the patient had already committed murder, so what did he have to lose? By using a ballpoint pen, a patient stabbed another nurse in the neck.

A psychiatrist on a ward where I worked was also attacked. After I left the office and building, the patient repeatedly hit the small woman psychiatrist with her handbag, which contained a heavy book. The psychiatrist had injuries to her shoulder and neck and went on sick leave for two months. The patient was immediately transferred to another hospital in the state, one for violent patients who had attacked, primarily, physicians.

None of this happened recently, and the violence at the two hospitals where I worked was always treated the same: transfer when an MD was attacked, quiet room for every other attack. The staff felt demeaned and resentful.

“The risk of workplace violence is not distributed evenly across specialty. Data shows that those who work in the emergency department, in geriatrics, or in psychiatry are substantially more likely to experience violence.”

Today, however, the level of violence, primarily at hospitals, is causing a sudden decision for nursing staff to seek other employment or leave the field entirely because of burnout or a lack of safety. Some estimates place the number of nurses leaving by 2027 at around 600,000. The result is that we have inadequate levels of staffing now, and it will get worse. In fact, hospitals are upping their recruitment abroad to supplement the paltry stream from US sources.

The rise in violence against medical professionals has had a substantial influence on the medical community, causing serious difficulties for both patient care and healthcare workers. Stressed and overworked healthcare professionals may degrade the standard of patient care. Also, the fear of violence can make it difficult for healthcare professionals to carry out their jobs properly, which can reduce productivity and increase the risk of patient care errors. In such a situation, what can be done?

How It Is Being Addressed

The media has been providing information on the issue, and both public awareness and education about it are needed. But is that enough? Obviously, an informed public is needed, but what steps are hospitals taking to protect and train their personnel?

According to research, healthcare is the profession where more violence occurs than in any other workplace, and about 654,000 personnel are injured each year. Yes, this is shocking, and I’m willing to play devil’s advocate here after reading what hospitals are proposing by way of decreasing violence in healthcare settings. No, I am not an expert on the matter, but some of the propositions appear to be circling the wagons without addressing some very real issues.

A perusal of the information that is being provided to healthcare personnel boils down to learning to de-escalate potentially violent incidents, educating the public and patients, planning for escape, where to hide, and how to call for help or security personnel. The one factor that is missing is the most distressing of all. The reasons for violence? Patient dissatisfaction, scarcity of mental health facilities, the opioid crisis, the pandemic—the list goes on.

Using a phrase that has become familiar to many of us, “You don’t bring a knife to a gunfight.” How does that apply here? I believe it is apparent that we are not more forcefully addressing the issue of gun availability, but not simply the ready supply of guns in stores.

The type of gun that is being used in almost all of these violent incidents is one meant for war. To more graphically present what these guns do, I have read in the research that the exit wound is the size of an orange, and survival is all but hopeless.

The issues are broader than employee and patient education, where to hide, or hospital protocols. To say that we are handling the question of gun violence in the US would seem to me to be somewhat naive or evasive. It’s a head-in-the-sand gesture when over 200 mass shootings occurred in the first half of 2023. Anyone wishing for more detailed information on gun violence can search the Gun Violence Archive.

Personnel shortages are only one result of the violence we are seeing. The future history books will carry a good deal of bold-faced type to underscore the recklessness we’ve encountered with regard to loss of life and our responses. The question remains: when will it stop?

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Nevertheless, six months ago the presidents of the colleges and universities in the Washington, D.C. region charged our organization, the Consortium of Universities of the Washington Metropolitan Area, with bringing together the best and brightest researchers across our institutions.  We came together for months of meetings and workings groups seeking to identify the potential solutions to reducing gun violence that showed the most promise.  To my surprise, we were able to find a great deal of common ground – although not without continuing areas of reasonable debate.

Gun violence itself is often misunderstood as focusing on mass shooting events, which themselves can be defined in different ways.  While those events are terrifying and receive tremendous coverage, far more people in our country die from suicide or homicide by gun than in mass shootings. 

Solutions have to start with understanding the causes of that violence, and we know that far more research is needed.  It seems evident to suggest that less ready access to guns would reduce suicide by gun, and likely homicides as well – yet according to our experts, gun buyback programs, which are often very comforting to a community, have had little impact on gun violence.

Community intervention programs were the single solution that found the most common ground in our discussions.  These programs engage local communities, sometimes through community-based organizations, schools, places of worship, or hospitals, in interrupting patterns of violence. 

They are very promising – and best of all, compared to most solutions, they are very inexpensive.  It is an area where far more investments should be made both in expanding and piloting programs, and in long term research in their outcomes.

Our experts also had many ideas for communication and education campaigns.  Of course, past public health campaigns have mixed results.  From encouraging use of seat belts to discouraging illegal drug abuse to COVID vaccinations, we can all readily remember campaigns that seem to have worked, and just as many that did not. 

Nevertheless, our experts highlighted a number of very targeted campaigns that were likely to generate success, including anti violence campaigns and conflict resolution training in schools, but only if they can be done without vilifying gun ownership.  Additionally, there was admiration for the very promising field of pushing back against online efforts by extremist groups to incite violence.

There seemed to be little or no downside to ideas surrounding increased safety and training.  Many of our most ardent gun rights supporters felt most passionately that providing easier access to safer gun storage and better training would make everyone safer. 

I was fortunate to be in the room for discussions with so many amazing experts giving their time and talent to respond to this crisis.  From them, I learned that all of these proposals will work best if aligned with wise legislation and policy, and that it is likely the best ways to reduce overall violence is to address root causes of economic equity and marginalization. 

It was shocking to me that the primary cause of death in children in our country has relatively little funding for research.  Most of all, it was hopeful to find that by collaborating across diverse thinkers from many disciplines, we were able to find that elusive common ground.  It made me believe, more than ever, that even on subjects where we have such deep divides, we can come together to find ways to make our children safer.

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Now it is time to put the fake news to bed regarding who are the individuals holding these weapons of death and slaughtering the innocents. No, they do not have a mental health condition, and to say that they are all mentally ill is incorrect and further stigmatizes persons with a mental health disorder. Statistics have shown us where the mayhem has been perpetrated regarding the states and who has been pulling the triggers.

The states with the highest incidence of firearms mortality include Alabama, Alaska, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, New Mexico, Oklahoma, South Carolina, Tennessee, and Wyoming. If you live in any of those states IMHO, you can be assured that you are at higher risk of encountering an individual with a gun who will kill you without hesitation. Then, there are the “stand your ground” laws.

Don’t chalk these murders up to mental illness. If you do, you are refusing to recognize that legally these murderers have the right to carry a gun, not just a gun, a military-quality assault rifle, anywhere they wish.

Don’t be in their fire line if you want to live. Perhaps, at some point, you’ll hesitate to leave your home. Indeed, you won’t want your children to go to school because you’ll wonder if they will ever return. No, this is not an advertisement for homeschooling, but that might realize an uptick in its popularity now.

And now, “open carry” is legal, so anyone wishing to have a sidearm with them when they go shopping, to the movies, or anywhere can have a firearm at their disposal. How many more instances of untamed violence, foolish behavior, or unintended slights will result in death for the intended and those who will be collateral damage?

If before we told people to “let the buyer beware,” now it’s “let everyone beware.” The genie is out of the bottle, and getting it back may prove nearly impossible.

A Brewing Death Storm

Usually, people don’t “snap” and become violent suddenly. There is a steady buildup of anger and a wish to get even many times, and some of the evident signs are frightening.

According to a friend, the killer in Uvalde, Texas, at the elementary school had a drug-addicted mother. His grandmother was evicting the latter from an apartment that the grandmother had rented for her.

The friend also told the media that the shooter had a pronounced speech problem, making him the target of bullies. On one occasion, he was seen by this friend with cuts all over his face and admitted that he had done it to himself. The situation was highly distressing, but nothing seems to have been done to remediate the problems.

The killings in Columbine also have roots in depression, suicidal thoughts, and lack of discovery by parents and schools. Blaming isn’t the way to come to some resolution of violent actions, as Sue Klebold, mother of one of the shooters, said in an interview.

She also noted that mental illness itself isn’t a risk factor for violence. It’s only through a combination of risk factors — including alcohol and drug abuse — that a person with a mood disorder is likely to hurt others.

What We Know About Guns

In the healthcare community, as I have known it, the thinking is that if guns are available, guns will be used. Responsible gun owners know that their guns must be secured and not always loaded.

But persons who fear for their safety, whether reasonable or not, may keep handguns in an area where they are easily accessible and loaded. Other gun owners, who use their weapons as intimidation, are a danger to everyone. I know someone who was never raised around guns and now sleeps with a loaded handgun under their pillow each night.

Overall, I believe that the mental health community understands that guns are a part of many American homes, especially in rural communities. There is no wish to outlaw guns, but there is a need for responsible use of guns, training in the use of guns, and careful consideration of gun ownership.

Legal gun owners are not those who are ordering ghost guns over the internet or trying to protect the interstate movement of Saturday night specials. There are legal gun activities used for sport, historic recreation events, and hunting. I once had a patient who belong to a historic events group. All the members loaded their own bullets and used historic guns in target practice contests.

But we do have to question the purchase of military-grade rifles by young persons or giving them a gift of such a weapon. These guns are a means to kill, not when hunting, but to inflate poor self-esteem IMHO. They are intimidating, and that’s the purpose. It is not only a foolish purchase or gift but a deadly one.

I am very concerned that loosening open carry as it relates to guns is a terrible precedent. It can only increase gun violence. We know that domestic violence begins with the first slap and then progresses to worse violence.

The same is true of the “peeping tom” who peers into windows and then goes on to rape and, possibly, murder his victims. These slow progressions are a danger to the entire community, and I think carrying a handgun wherever you go cannot end well.

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