June 10, 2022

Dear OMIC Insureds:

Healthcare workers are five times more likely to experience workplace violence than workers in all other industries. Between 2011 and 2018, injury arising from violence against medical professionals increased by 67%, according to the U.S. Bureau of Labor Statistics, and in 2018 it reported that 73% of all nonfatal workplace assaults and injuries occurred in healthcare settings. The World Health Organization estimates that up to 38% of healthcare workers suffer physical violence at some point in their careers, and many more will be the targets of threats and verbal abuse. Studies conducted since the onset of the pandemic suggest that this number is increasing. In 2020 Dye et al. found that health professionals were roughly 50% more likely than other community members to have been harassed, bullied, or hurt as a result of the COVID-19 pandemic.

Fortunately, violent attacks by patients against staff and physicians in the clinical office are rare, but over the years insureds have reported incidents of stalking and physical harm by their patients. A more frequent occurrence are patients who are verbally abusive and threaten litigation. Triggers for aggressive behavior can include a multitude of items, such as receipt of a serious, vision-threatening diagnosis, an unexpected outcome after surgery, a billing issue, the requirement to adhere to protocols, or a long time in the waiting room. These episodes are sometimes accompanied by a demand for a refund or the threat of posting a negative review on social media. Since the pandemic began, we’ve listened to many insureds describe patients who have become agitated regarding compliance with safety precautions, and assert that their civil rights are being violated.

One way to address aggressive behavior by patients, and reduce the stress resulting from such instances, is to be prepared for them:

1. 1. Make sure your staff understand the many forms of abuse, such as verbal harassment, threats, or abusive language; shouting; inappropriate gestures; racist or derogatory comments directed at others; sexual language directed at others; failure to respond to staff instructions, including failure to comply with COVID-19 safety precautions; physical assault; stalking.
   
2. 2. Provide a plan for managing aggressive behavior: Dealing with a disruptive patient . One of our insureds gave us permission to share their protocol, which you can adapt for your practice: OCB-Policy-to-Handle-Disruptive-Patients-2.
   
3. 3. Maintain the policy in a place that is easily accessible by all staff. Review the policy with staff periodically and make it a part of your new-employee training.
   
4. 4. You may terminate a patient immediately (without offering the 30-day period for emergency care) due to violent behavior (see pp. 2 and 6): https://www.omic.com/Terminating the Physician Patient Relationship
   
5. 5. Consider displaying a small placard at the reception desk or elsewhere in the waiting area that states your zero-tolerance policy regarding aggressive behavior.
   
6. 6. Many EHRs have flags that can alert staff about various patient issues. This may be a useful tool for patients who have shown a pattern of escalating behavior.
   
7. 7. If there is the threat of immediate danger, call 911, as well as any other security services available in your building. 

If you have questions, contact us for confidential risk management advice at riskmanagement@omic.com or call us at 1-800-562-6642 and enter 4 for Risk Management. 

Sincerely,

Linda D. Harrison, PhD
Vice President, OMIC Risk Management

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