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Michael Radzienda, MD, SFHM, vice president of hospital medicine and clinical effectiveness at Vanguard Health System in Southborough, Mass., says the recent shooting of a doctor at Johns Hopkins Hospital in Baltimore serves as a stark reminder that violence in the hospital is a concern for providers more than ever. To Dr. Radzienda’s mind, that includes patients attacking doctors or patients attacking other patients.
"It’s a newer issue for hospitalists, but one that they need to pay attention to," Dr. Radzienda says. "The volume of high-risk interactions that a hospitalist might have is significant compared to what that volume might have looked like 10 years ago before the hospitalist (model) took off."
And while one might think the incident at Johns Hopkins is enough to shine a lasting spotlight on the issue, a report from The Joint Commission this summer on hospital violence faded relatively quickly after its issuance. The commission’s Sentinel Event Database, in fact, includes a category of assault, rape, and homicide (combined) with 256 reports since 1995, a number the organization suggests is under-reported. The commission’s latest report, published in June, found that since 2004, hospitals have reported "significant increases in reports of assault, rape, and homicide, with the greater number of reports in the last three years."
The report recommends physicians learn techniques to identify potentially violent patients, implement violence de-escalation approaches, and even conduct violence audits to help determine an institution’s safety protocols.
Dr. Radzienda understands that training time and resources are stretched thin, but he says more focus on violence would be helpful to institutions and individual physicians. "The problem is someone needs to recognize this type of thing," he says. "But how do you prioritize that?"