Protection from violent assaults and infection

Staying safe

Protection from violent assaults and infection top practice safety lists. Howard Larkin reports

Doctors being abused and attacked over COVID-19 concerns.” “Second wave brings new reports of ‘awful’ abuse against nurses.”

These are some of the headlines in the news today, said Christopher Teng MD, associate professor of ophthalmology and visual science at Yale School of Medicine, New Haven, Connecticut, USA. Protecting your practice staff and yourself against an increase in violent activity is emerging as a concern during the pandemic, according to Dr Teng and others on a disaster preparedness panel at AAO 2020 Virtual.

In a recent survey by the UK’s Medical Protection Society, more than one-third of doctors reported they had suffered verbal or physical abuse from patients during the COVID-19 outbreak, including being assaulted and shouted at in the street, Dr Teng said.

But while the pandemic has played a role in shortening fuses, even before the 2020 outbreak violence against doctors was a significant problem. Indeed, healthcare is one of the more dangerous occupations, said Ranya Habash MD, medical director for technology innovation at Bascom Palmer Eye Institute, Miami, USA.

Nearly half of emergency department physicians reported being assaulted in the emergency room and 71% have witnessed an assault, according to studies by the American College of Emergency Physicians and the US Bureau of Labour Statistics. And healthcare workers are about four times more likely to suffer violence at work than construction workers.

PANIC BUTTON Dr Teng recommends taking precautions. A few years ago, a colleague in his practice was assaulted. “We were not fully prepared. Silent alarms were not active, we did not know how to optimally handle the situation, there was no safe room.

“Since then, we have implemented de-escalation trainings, activated alarms at the front desk, installed keyboard alarm systems and created a locked area,” Dr Teng said. “Ask yourself this question: what if there were a violent act in my office against a staff member or doctor? What would I do?”

Dr Teng recommended talking about the risk of violence with partners, associates and staff, and coming up with a plan. Take training courses. Create an exit plan or safe area. Know when to run, hide or fight.

“Our exams are in closed-door rooms. Consider outfitting every room with panic buttons or alarms, keyboard buttons, silent alarms or even airhorns. You can never be overprepared.”

Installing alarms can be as simple as downloading an app, said Dr Habash, who is also chief medical officer for Everbridge, a safety technology concern. The firm’s software offerings include a tracking programme with a virtual panic button. It can instantly tell event managers and security personnel where an incident is taking place.

“We have had a lot of success with that in large health systems.” Often, assaults take place outside or in parking area, and mobile security devices are especially helpful for these, Dr Habash noted.

PROTECTING STAFF & PATIENTS When patients must be seen after hours, consider having a second team member come to help ensure safety, log into an app, or have patients be seen in an emergency department, though this may be less convenient for some patients such as postoperative patients, Dr Teng said. At Bascom Palmer, patients are almost always seen by telemedicine first both outside and inside the hospital, and residents are typically sent to in-person visits whenever appropriate to reduce exposure for older doctors at higher risk of infection, Dr Habash said.

At the Eye Clinic of Florida in Zephyrhills, Florida, USA, in addition to the usual wipe-downs, masks and other hygiene measures, a robot with ultraviolet lights

We were not fully prepared. Silent alarms were not active, we did not know how to optimally handle the situation...

A robot with UV lights is sent in to help sanitise rooms between patients at the Eye Clinic of Florida in Zephyrhills, Florida, USA Courtesy of Ahad Mahootchi MD

is sent in to help sanitise rooms between patients, said Ahad Mahootchi MD.

The clinic publishes pictures of staff hugging the robot as part of an overall effort to communicate to patients that the clinic takes their safety seriously. “I think that really breaks the ice with a lot of people who are scared to come in.” The message is also reinforced in phone calls to patients before visits, and helps reduce cancellations, which currently run about 15%, Dr Mahootchi said.

Assessing and documenting steps you take to keep patients and staff safe are essential for ongoing success, said Steven Yeh MD, professor of ophthalmology at the Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA. He recommended that clinics develop a leadership task force to identify personnel for decision-making, implementation and communication of protocols to keep the clinic safe during a public health emergency.

In addition, Dr Yeh recommends a thorough review of processes as an institution to assess clinic performance and response and to identify areas where new knowledge or procedures are needed to improve responses to emergencies of all kinds.

“We clearly need to anticipate infectious disease outbreaks as they can affect our collective global health and vision health communities,” Dr Yeh said.