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Tackling ER Violence with RTLS at Beaumont Health System

August 22, 2013
by Rajiv Leventhal
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Real-time system offers proximity-based alerting capabilities with panic button functionality
Terry Kowalenko, M.D.

Emergency rooms (ERs) are often a place where nurses, physicians, surgeons, and other medical staff provide care in an unplanned nature. It would be reasonable to assume that the healthcare professionals who provide this care would be treated with great respect, given the intense pressure they are asked to perform under.

Some of the time though, that is not the case. According to latest figures from the national Emergency Nurses Association, between January 2010 and January 2011, more than half of ER nurses—53.4 percent—reported experiencing verbal abuse, and about 13 percent said they had encountered physical violence at work in the previous week.

What’s more, in a study published in the January issue of the American Journal of Emergency Medicine, Terry Kowalenko, M.D., health system chair of emergency medicine for Beaumont Health—a three-hospital health system in Royal Oak, Mich. with 1,738 licensed beds—and colleagues from the University of Cincinnati surveyed 213 emergency department workers monthly at six hospitals in Michigan and Ohio. Over nine months, the hospital employees reported 827 violent events, including 601 threats of violence and 226 actual assaults. The stress that resulted, the study reported, significantly affected workers’ productivity and their ability to think on the job.

Both Kowalenko’s and the Emergency Nurses’ studies found that there is significant under-reporting of ER incidents. Assault victims filed safety reports only 42 percent of the time in Kowalenko’s study, and police reports 5 percent of the time. And the Institute for Emergency Nursing Research found that 65.6 percent of nurses who were victims of physical abuse did not file a formal report, according to The Detroit News.

The matter has gotten the attention of Michigan lawmakers. The Senate passed a bill in June that would make assaulting an on-duty health worker punishable by the same penalty as assaulting a police officer or a firefighter: up to four years imprisonment and a $5,000 fine. At least 26 states have passed similar laws, The Detroit News reported.

 “When more than half of safety reports are not being reported, you know this is a much bigger problem than it appears,” says Kowalenko. “The staff is obviously worried, because if you’re the person who reports everything, and another person reports nothing, it may look as if you’re the problem rather than there being problem in your healthcare setting.” Kowalenko adds that the workplace violence has affected healthcare professionals’ ability to work in that environment, as some have left the emergency department, while several others considered leaving.

Another problem is that many of the reporting systems in hospitals that Kowalenko studied can be laborious for a busy medical staff. It takes time in a busy work day to sit down and report incidents, via paper, or even a computer system, he says. “Workers in general also have a higher threshold for what they would report as a ‘violent’ incident. In the study, I would see something and mention it, and a worker might say, ‘I was pushed, but it wasn’t a big deal.’ I would respond by saying, ‘If you were a waiter or waitress in a restaurant, what would happen? Would that person still be served?’ Unfortunately, it’s been around for so long and we keep getting exposed to it, so our threshold keeps going up and up.”


The types of ER violence, according to Kowalenko, can include: kicking, scratching, spitting, pushing, biting, throwing objects, pulling hair, grabbing, and pinching. Beaumont Hospital officials noticed a rising trend in these incidents, and realized it was time to take action, says Chris Hengstebeck, system director of security, overseeing all three Beaumont facilities.

Beaumont engaged in a pilot with Ekahau Inc., a Reston, Va.-based provider of real-time location systems (RTLS) in 2012, in an attempt to beef up its response times to violent occurrences. The security badge that Ekahau provides disengages—so if an employee pulls on it, it creates a trigger that alerts Beaumont’s security operations center. In the center, there is a map that locates that device, so hospital officials can dispatch to that floor immediately, but also give officers information if that badge is moving down the hall or to another room, explains Hengstebeck.

Employees who feel threatened pull down on the badge’s panic switch, and his/her location appears on badges worn by employees near the incident. Ekahau’s wearable radio-frequency identification (RFID) badges offer proximity-based messaging via text, and operate over the existing wireless local area network (WLAN), eliminating the need for manual panic button presses, dialing and map look-ups.

“We were skeptical when this system came out, but became surprised how sophisticated and user-friendly it was,” says Hengstebeck . “We decided to invest in the larger system, and now we have it in all inpatient units and ER centers. It’s not a failsafe, but it’s a tool that gives us a better ability to respond in a timely manner to a volatile situation.”

Hengstebeck adds that while there was a bit of a learning curve, the biggest challenge has been false alarms. “When we get these alarms, we treat it as worst-case scenario. We send troops running. Our dispatchers, while dispatching, also follow a phone call to a unit to see what’s going on. Often though, it’s a false alarm. If you get tied up and pull the badge and don’t realize the signal goes off, before you know it, security is there. That’s an issue we’re working on.”

While this real-time technology certainly can help with response time during violent incidents, Kowalenko says it is important to focus on prevention as well. “Recognizing the potentially violent person, having the ability to diffuse the situation, using conflict management, calming [him/her] down, and getting [him/her] in a calmer, quieter, darker environment will help. Keep the patient as comfortable as possible and well-informed, and treat [him/her] with respect,” he advises.

It’s also important to think of the clientele that comes in, from the 90-year-old dementia patient who wakes up in the middle of the night, has a horrid dream and lashes out to someone who is going through delirium tremens (DTs), says Hengstebeck. “They all have predictable episodes of volatile behavior and potential violence. All of our staff recognizes that as taking care of the sick and dying. It’s about having another tool to having security respond a little quicker than if they didn’t have it.”

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