Question:

Emergency Departments have been volatile places for a time now, so our hospital has had a policy on managing difficult ED patients for a while.  But now our staff is clamoring about disruptive inpatients and visitors, Security wants to post large “no weapons allowed” signs at all access points of the hospital, and searching patients and visitors has been raised.  What kind of policies are hospitals putting into place to try to manage all of this?  And just what the heck is going on?

Answer:

Patient violence and disruption are becoming increasingly common, and scary.  Violence (or the threat of it) has led hospitals to adopt no weapons policies, which include appropriate signage and the searching of patients and visitors, as needed, in the ED.  Disruptive patient policies are becoming more common.  (Disruptive patients are different from violent patients.  Disruptive patients are noncompliant as to hospital rules, respecting staff and personnel, and rules of civility.)   Disruptive family members of patients are not uncommon.  Hospitals have adopted policies concerning the taking of audio recordings, photographs or moving images by cell phone or other handheld devices to prevent visitors from taping the care of patients (for potential use against those providing the care).   In-service programs on defusing violence and/or escalating situations are often held in multiple hospital units, not simply the ED.  Outpatient clinics and practices are dealing with more disruptive patients and visitors.  Physicians are trying to deal with patients who are getting multiple medication prescriptions from multiple providers. (These patients often use multiple pharmacies to prevent discovery of their ruse.)   Physician “firings” of patients because of this behavior are on the rise.  So are firings due to patient noncompliant behavior.

The reasons for all this?  There are many:  enhanced levels of stress (high unemployment and depressed wages); mental instability issues (psychiatric and drug and alcohol-based); societal breakdowns in civil behavior; hospitals as prime spots for emotional distress, outbursts and confrontations; hospitals open 24 hours a day; the list goes on and on.  There is no easy answer to this, nor any one answer.  That’s why we are seeing hospitals adopting more behavioral policies of these kinds (and behavioral patient treatment contracts) to try to manage difficult situations in all parts of the hospital, and with all populations of the hospital.