Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial

BMC Health Services Research

Antoine Duclos⁴  Carole Burillon²  Marie-Annick Le Pogam¹  Jean-Baptiste Fassier³  Pierre-Loïc Cornut²  Sandrine Touzet⁴ 

[1] Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne CH-1010, Switzerland;Hospices Civils de Lyon, Hôpital Edouard Herriot, service d’ophtalmologie, Lyon F-69003, France;Université de Lyon, UMR T 9405, Lyon F-69373, France;Université de Lyon, EA Santé-Individu-Société 4128, Lyon F-69002, France

关键词: Alternating time series design;    Assault;    Violence;    Healthcare workers;    Workplace violence;    Ophthalmology;    Emergency unit;   

Others  :  1131137
DOI  :  10.1186/1472-6963-14-221

 received in 2014-04-28, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital.

Methods/Design

This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded.

Discussion

The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof.

The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).

【 授权许可】

   
2014 Touzet et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]National Institute for Occupational Safety and Health (NIOSH): Current Intelligence Bulletin 57: Violence in the workplace; risk factors and prevention strategies. Cincinnati, OH: National Institute for Occupational Safety and Health; US Department of Health and Human Services, Public Health Service, Center for Disease Control and Prevention. 1996. [http://www.cdc.gov/niosh/docs/96-100/ webcite]
• [2]Lee F: Violence in A&E: the role of training and self-efficacy. Nurs Stand 2001, 15:33-38.
• [3]Winstanley S, Whittington R: Aggression towards health care staff in a UK general hospital: variation among professions and departments. J Clin Nurs 2004, 13:3-10.
• [4]Saines JC: Violence and aggression in A&E: recommendations for action. Accid Emerg Nurs 1999, 7:8-12.
• [5]Lyneham J: Violence in New SouthWales emergency departments. Aust J Adv Nurs 2000, 18:8-17.
• [6]Ryan D, Maguire J: Aggression and violence - a problem in Irish Accident and Emergency departments? J Nurs Manag 2006, 14:106-115.
• [7]Crilly J, Chaboyer W, Creedy D: Violence towards emergency department nurses by patients. Accid Emerg Nurs 2003, 12:67-73.
• [8]Lau JB, Magarey J, McCutcheon H: Violence in the emergency department: a literature review. Aust Emerg Nurs J 2004, 7:27-37.
• [9]Ferrari R: Observatoire National des Violences en milieu de santé. Rapport annuel 2012. Ministère des Affaires Sociales et de la Santé. [http://www.sante.gouv.fr/IMG/pdf/bilan_2012_ONVS-2.pdf webcite]
• [10]Parent-Thirion A, Fernández Macías E, Hurley J: Violence, harassment and discrimination in the workplace, in Fourth European working conditions survey. 2007, European Foundation for the Improvement of Living and Working Conditions. Luxembourg: Office for official publications of the European communities; [http://edz.bib.uni-mannheim.de/daten/edz-ma/esl/07/ef0698_en.pdf webcite]
• [11]Bué I, Sandret N: Contact avec le public : près d’un salarié sur quatre subit des agressions verbales. Documents pour le médecin du travail 2007, 110:193-197.
• [12]Institut National de Recherche et de Sécurité: Travail et agressions : Etat des lieux et prévention des risques 2003. [http://www.inrs.fr/dossiers/agression.html webcite]
• [13]Lavoie FW, Carter GL, Danzl DF, Berg RL: Emergency department violence in United States teaching hospitals. Ann Emerg Med 1988, 17:1227-1233.
• [14]Flannery RB: Violence in the workplace, 1970–1995: a review of the literature. Aggress Violent Behav 1996, 1:57-68.
• [15]Fernandes CM, Bouthillette F, Raboud JM, Bullock L, Moore CF, Christenson JM, Grafstein E, Rae S, Ouellet L, Gillrie C, Way M: Violence in the emergency department: a survey of health care workers. CMAJ 1999, 161:1245-1248.
• [16]Dorevitch S, Forst L: The occupational hazards of emergency physicians. Am J Emerg Med 2000, 18:300-311.
• [17]McGovern P, Kochevar L, Lohman W, Zaidman B, Gerberich SG, Nyman J, Findorff-Dennis M: The cost of work-related physical assaults in Minnesota. Health Serv Res 2000, 35:663-686.
• [18]Jenkins MG, Rocke LG, McNicholl BP, Hughes DM: Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and Republic of Ireland. J Accid Emerg Med 1998, 15:262-265.
• [19]Gates DM, Ross CS, McQueen L: Violence against emergency department workers. J Emerg Med 2006, 31:331-337.
• [20]Hodge AN, Marshall AP: Violence and aggression in the emergency department: a critical care perspective. Aust Crit Care 2007, 20:61-67.
• [21]Garnham P: Understanding and dealing with anger, aggression and violence. Nurs Stand 2001, 16:37-42.
• [22]Chan TC, Killeen JP, Kelly D, Guss DA: Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Ann Emerg Med 2005, 46:491-497.
• [23]Casagrande JT, Pike MC, Smith PG: An improved approximate formula for calculating sample sizes for comparing two binomial distributions. Biometrics 1978, 34:483-486.
• [24]Edwards SJ, Braunholtz DA, Lilford RJ, Stevens AJ: Ethical issues in the design and conduct of cluster randomised controlled trials. BMJ 1999, 318:1407-1409.
• [25]Durieux P, Ravaud P: Méthodes quantitatives pour évaluer les interventions visant à améliorer les pratiques. Haute Autotritéde Santé. 2007. [http://www.has-sante.fr/portail/upload/docs/application/pdf/eval_interventions_ameliorer_pratiques_guide.pdf webcite]
• [26]Durieux P, Nizard R, Ravaud P, Mounier N, Lepage E: A clinical decision support system for prevention of venous thromboembolism: effect on physician behavior. JAMA 2000, 283:2816-2821.
• [27]Colombet I, Bura-Rivière A, Chatila R, Chatellier G, Durieux P, PHRC-OAT study group: Personalized versus non-personalized computerized decision support system to increase therapeutic quality control of oral anticoagulant therapy: an alternating time series analysis. BMC Health Serv Res 2004, 4:27. BioMed Central Full Text
• [28]Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D: The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986, 143:35-39.
• [29]Mahoney BS: The extent, nature, and response to victimization of emergency nurses in Pennsylvania. J Emerg Nurs 1991, 17:282-294.
• [30]Keep N, Glibert PP, 1990-1991 California ENA Government Affairs Committee: California Emergency Nurses Association’s informal survey of violence in California emergency departments. J Emerg Nurs 1992, 18:433-439.
• [31]Levin PF, Hewitt JB, Misner ST: Insights of nurses about assault in hospital based emergency departments. Image J Nurs Sch 1998, 30:249-254.
• [32]Knowles E, Mason SM, Moriarty F: ‘I’m going to learn how to run quick’: exploring violence directed towards staff in the Emergency Department. Emerg Med J 2013, 30:926-931.
• [33]Cembrowicz SP, Shepherd JP: Violence in the accident and emergency department. Med Sci Law 1992, 32:118-122.
• [34]Morgan MM, Steedman DJ: Violence in the accident and emergency department. Health Bull 1985, 43:278-282.
• [35]Rose M: A survey of violence towards staff in one large Irish Accident and Emergency Department. J Emerg Nurs 1997, 23:214-219.
• [36]Kowalenko T, Cunningham R, Sachs CJ, Gore R, Barata IA, Gates D, Hargarten SW, Josephson EB, Kamat S, Kerr HD, McClain A: Workplace violence in emergency medicine: current knowledge and future directions. J Emerg Med 2012, 43:523-531.
• [37]Runyan CW, Zakocs RC, Zwerling C: Administrative and behavioral interventions for workplace violence prevention. Am J Prev Med 2000, 18(4 Suppl):116-127.
• [38]Caskey CR: Workplace violence. Clin Lab Sci 2001, 14:95-100.
• [39]Fernandes CM, Raboud JM, Christenson JM, Bouthillette F, Bullock L, Ouellet L, Moore C, Violence in the Emergency Department Study (VITES) Group: The effect of an education program on violence in the emergency department. Ann Emerg Med 2002, 39:47-55.
• [40]Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, Camargo CA Jr, Blumenthal D: A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med 2008, 15:1268-1274.
• [41]Jackson FJ, Flinn RJ: Health care security: the emergency room view on violence. J Healthc Prot Manage 1997, 13:31-36.
• [42]Merchant JA, Lundell JA: Workplace violence intervention research workshop, April 5–7, 2000, Washington, DC. Background, rationale, and summary. Am J Prev Med 2001, 20:135-140.
• [43]Wiler JL, Gentle C, Halfpenny JM, Heins A, Mehrotra A, Mikhail MG, Fite D: Optimizing emergency department front-end operations. Ann Emerg Med 2010, 55:142-160.
• [44]Burt CW, McCaig KF: Staffing, capacity, and ambulance diversion: United States, 2003–04. Adv Data 2006, 376:1-24.
• [45]Medley DB, Morris JE, Stone CK, Song J, Delmas T, Thakrar K: An association between occupancy rates in the emergency department and rates of violence toward staff. J Emerg Med. 2012, 43:736-744.
• [46]Gerdtz MF, Bucknall TK: Triage nurses clinical decision-making. An observational study of urgency assessment. J of Adv Nurs 2001, 35:550-561.
• [47]Lee KM, Wong TW, Chan R, Lau CC, Fu YK, Fung KH: Accuracy and efficiency of X-ray requests initiated by triage nurses in an accident and emergency department. Accid Emerg Nurs 1996, 4:179-181.
• [48]Keizer K, Lindenberg S, Steg L: The spreading of disorder. Science 2008, 322:1681-1685.
• [49]Cowin L, Davies R, Estall G, Berlin T, Fitzgerald M, Hoot S: De-escalating aggression and violence in the mental health setting. Int J Ment Health Nurs 2003, 12:64-73.
• [50]Kao LW, Moore GP: The violent patient: clinical management, use of physical and chemical restraints, and medicolegal concerns. Emerg Med Pract 1999, 1:1-24.