#Emergency physician residents and health care workers at high risk of physical or verbal assault, new analysis shows

A new study in Annals of Emergency Medicine highlights the importance of protecting physician residents—early-career doctors still in training—and emergency care teams from incidents of physical or verbal abuse.

The survey of 123 physicians, residents, and staff in one emergency department found that 78 percent of all health care workers experienced a violent assault in the prior 12 months, including more than one in five (22 percent) emergency physician residents. Eighty-nine percent of residents experienced verbal assault by a patient in the prior 12 months, compared to 80 percent of other health care workers.

“Violent or threatening incidents in the emergency department pose risks to everyone’s safety but can also impact health workers’ mental health and may increase the likelihood of burnout,” said Lauren Querin, MD, MS, lead author and emergency physician with the University of North Carolina (UNC) Chapel Hill Department of Emergency Medicine. “These encounters happen frequently and often go unreported.”

Of the total respondents who experienced physical assault or violence, 19 percent did not discuss the incident with anyone. About half (53 percent) only discussed the incident with colleagues while only 20 percent filed a formal incident report with the hospital or police. Among residents, 96 percent discussed incidents with only a colleague or no one at all. None of the residents filed formal reports.

Residents’ experience with assault became more common with time in the program, the analysis shows. Sixty-two percent of first year residents and 100 percent of second- and third-year residents experienced verbal assault. While no first-year residents reported a physical assault, 25 percent of second-year residents and 36 percent of third-year residents indicated that they have been physically assaulted.

“More can be done to make sure that every member of the emergency care team can prioritize patient care rather than worrying about their own safety at work,” said RJ Sontag, MD, president of the Emergency Medicine Residents’ Association (EMRA). “This study looks at one emergency department but stories like these are common nationwide. We must empower residents and others to report these incidents and take the necessary steps to protect health care workers and patients.”

Only 24 percent of the residents believe that workplace violence protocols in place at their facility are adequate while 30 percent do not think the protections are sufficient and 38 percent were unsure. Eight percent were not certain what the protocols were.

Anonymous firsthand accounts of violence, sexual assault, or personal threats are detailed in the analysis.

One resident reported that a patient being discharged threatened to “come find me and shoot me in the kneecaps.”

Another resident commented, “I was not only scared for myself and other staff…but also scared regarding the injuries the patient would sustain and I would need to treat.”

This qualitative analysis echoes findings from a 2018 poll of more than 3,500 emergency physicians across the nation from the American College of Emergency Physicians (ACEP). ACEP is leading efforts with physicians, hospitals, care teams, regulators, and policymakers to address violence in the emergency department, including extensive work to support the introduction of the “Workplace Violence Prevention for Health Care and Social Service Workers Act of 2021,” by Rep. Joe Courtney (D-CT) and a bipartisan coalition in the House of Representatives.

For its members, ACEP offers education, training, and advocacy opportunities aimed at curbing violence in the emergency department. The association also launched “No Silence on ED Violence,” a campaign with the Emergency Nurses Association (ENA) that gives those impacted a chance to share stories and increase awareness of workplace violence while providing resources and a peer network that supports emergency nurses and physicians.