Surging violence in emergency departments is burning out physicians and jeopardizing patient care, new data show

Emergency physicians responding to an August poll are reporting more frequent incidents of violence in emergency departments in recent years, a trend they say is helping drive professionals from the field and directly harming their ability to care for patients.

Fifty-five percent of emergency physicians say they have been assaulted in the ED while 79% say they have witnessed another assault, according to an August survey of more than 2,700 respondents commissioned by the American College of Emergency Physicians (ACEP).

These numbers were up from the 47% and 71%, respectively, who indicated similarly during a 2018 poll of over 3,500 emergency physicians.

“There’s a robust amount of data that the unfortunate incidence of ED violence is not only there but it continues to rise,” Christopher Kang, M.D., president-elect of ACEP, said during a virtual presentation of the survey data. “At this time, given the current measures, given the current support that we receive from various stakeholders, unfortunately we believe this cycle is going to continue to rise and 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.”

Among those who said they had ever been physically assaulted, two-thirds said they had been assaulted at least once within the past year while 36% said they had been assaulted multiple times within the past year.

Twenty-eight percent of those who said in 2018 that they had ever been physically assaulted indicated multiple ED attacks within the past year, suggesting that the frequency of assaults individual physicians are experiencing has increased, ACEP wrote in its report on the survey responses.

"The incidence has simply exploded," Alex Skog, M.D., president-elect of ACEP’s Oregon chapter, said during the presentation.

A third of those who said they were assaulted said their attack resulted in an injury, ACEP wrote, a 6% increase over the 2018 responses. The portion of assaulted respondents who said they missed part of or their entire shift due to injury also increased by 50% since 2018, the group found.

However, verbal assault or threats of violence were the most prevalent forms of assault reported by physicians (64%). These were followed by hits and slaps (40%), spit (31%), punches (29%), kicks (26%), scratches (19%), bites (6%) and use of a weapon (3%).

Emergency physicians’ personal experiences were accompanied by a widespread belief that the emergency room has become a more dangerous place.

Eighty-five percent of the polled emergency physicians said they believed the rate of violence has increased over the past five years, compared to the 69% who indicated similarly during the 2018 survey. Forty-five percent of those responding to this year’s polls said they believed emergency room violence had greatly increased versus 2018’s 25%.

More specifically, 66% of this year’s respondents said they believed the COVID-19 pandemic was responsible for an increase in ED violence. Sixty-nine percent blamed the pandemic for a decrease in trust between patients and providers.

The percentage of physicians who said they believed violence in the ED has harmed patient care increased from 77% in 2018 to 89% in 2022.

Among the more recent respondents noting worsened patient care, loss of productivity (87%), emotional trauma or increased anxiety (85%), longer wait times (85%) and less focus from providers (84%) were each listed as the leading adverse effects on patient care resulting from ED violence.

Both Kang and Skog pointed to the survey data and their own interactions with fellow providers as warnings of increasing burnout and departures from the field.

The latter shared stories of physical assaults he’d witnessed, requests from staff not to be assigned to the ED and the stress he experienced when a COVID patient’s family member pointed to a gun holster and threatened the lives of his family after hearing that the patient needed to be admitted.

“I feel privileged to have worked shoulder by shoulder with these dedicated medical professionals through the uncertainty, fear and struggle of the pandemic,” Skog said during the virtual press conference. “But now more than ever, I fear that we will lose these front-line medical professionals unless action to increase the accountability and add protections in the ED is addressed with the seriousness and urgency required to stem the tide of violence.”

Kang highlighted survey responses indicating limited hospital responses following incidents of physical assault in the ED.

Just over a quarter of respondents said there was no response from the hospital, and those who did most frequently (29%) did so by placing a behavioral flag into the patient’s medical chart to warn future providers. Only 2% whose hospital responded said their hospital pressed charges following the physical assault.

Kang shifted some of the blame off hospitals, saying their “inconsistent” legal action or law enforcement engagement can be heavily affected by a state’s requirements or legislation surrounding healthcare violence.

Alongside a plea for hospital leaders to ensure their physicians and workers investigate the appropriate safety measures for their facilities and workforces, the ACEP leaders called on Congress to pass two recently proposed bills focused on nationwide healthcare worker safety: the Workplace Violence Prevention Act for Health Care and Social Service Workers Act (passed in the House) and the Safety from Violence for Healthcare Employees Act (awaiting consideration by the House Judiciary Committee).

“This is a complicated issue, and there is not a single silver bullet answer,” Skog said. “But we do believe that with added attention to this effort from consensually all parties and all parts of our communities, we can get to a place where we can have a safe working environment and really be able to provide the best possible emergency care to our communities members.”