By David Unze
A hospital is where people are treated for injuries, not a place where they get injured.
That may seem like a simple, no-brainer statement. But after St. Cloud Hospital saw an increase in assaultive behavior by patients, a trend seen in health care facilities in other parts of the country as well, it ramped up security efforts that it said were already industry-leading.
The additional security measures, more of which are coming soon, are designed to echo what administrators are saying: There is no tolerance for violence in the hospital.
“We’re far ahead of other places, but we went to a zero-tolerance policy, and that means no assaults at all,” said Bill Becker, director of security and safety at the hospital. “We’re here to take care of you, not be beaten up.”
Ways that the hospital has increased security include:
- Having a St. Cloud police officer assigned to the Emergency Trauma Center on Friday and Saturday nights.
- Pressing charges against anyone who assaults staff or damages hospital property.
- Adding security cameras in the Emergency Trauma Center garage and locking the doors from the garage to the ETC. The hospital plans to eventually relocate the ETC’s public entrance and make the garage accessible only to emergency medical personnel and police.
- Requiring all employees to attend training on violence prevention and aggression management.
- Requiring a photo ID for entry to the secure Family Birthing Center and requiring visitors to wear a hospital-issued security badge.
The hospital has had a metal detector for several years and cameras throughout the facility. It has plans to create a locked unit within the ETC for at-risk individuals who need to be in a safe environment. That unit would be for intoxicated people and those with mental health issues, among others.
And the ETC has the ability to go into a lockdown mode that secures it from the rest of the facility and prevents movement into or out of the area during a crisis.
Violence against health care workers is a growing problem at the hospital and across the country, said Jeanine Nistler, director of communications for CentraCare Health System.
The problem was outlined in an article in 2010 published in the Journal of the American Medical Association. The article showed that the rate of assaults on workers in U.S. health care settings is four times higher than other workplaces.
The rate of assault on employees in all private-sector industries in the United States is two per 10,000 per year, compared with eight per 10,000 at health care workplaces, according to the article. One of the authors was Dr. Gabor D. Kelen, professor and chair of the Johns Hopkins Department of Emergency Medicine.
The issue prompted the Emergency Nurses Association to develop an “Advocacy Packet on Mitigating Violence against Healthcare Workers” that provides data, tools and resources for managers to establish zero tolerance for violence in hospital emergency departments, Nistler said.
St. Cloud Hospital spent late 2011 and early this year training workers with the goal of avoiding what Becker called “code greens.”
That’s when an out-of-control patient leads to a call to one of Becker’s security staff. In reviewing the code greens, he found that there often was a security issue in another part of the hospital before the code green was called.
“So part of our education is telling staff that if they feel a situation is getting out of control to call us,” Becker said. “Because when we get there, usually the (code) greens don’t happen. So after that education we saw a big drop in code greens, but of course our security calls are up, which is fine. Because that’s what we’re here for. So we get there before the patient, for whatever reason, gets out of control and somebody gets hurt.”
Becker found that the majority of the incidents involved a patient under the influence of alcohol or drugs assaulting a hospital staff member. And what was alarming was that it wasn’t just that assaults were increasing.
“We’ve had the increase in incidents, which has caused us to take additional steps. But part of it has been the nature of the incidents,” Nistler said. “People got hurt.”
And it’s not just in the emergency room. Becker, during a recent interview, recounted instances of domestic assaults in of all places, the birthing center.
The hospital is taking more patients who usually would go to detox, whether because detox is full or because there is a medical condition that requires them to go to the hospital.
“We’re detoxifying patients more and more,” Becker said.
He also has seen an increase in the number of patients who know how to manipulate the system so they are taken to the hospital rather than detox. He referred to that as people “playing the psych card.”
Another factor impacting Becker’s staff is the increase in the size of the hospital, which recently underwent a $223 million expansion. He’s added the equivalent of 1.4 security employees in the last year.
The hospital also is paying to have a St. Cloud police officer patrol the emergency room on Friday and Saturdays from 8 p.m. to 4 a.m., said Sgt. Marty Sayre of the St. Cloud Police Department.
The hospital has had metal detectors since 2004, and it screens trauma center visitors 24-7. That is also the after-hours entrance, meaning everyone who comes into the hospital after 9 p.m. goes through the metal detector.
Becker keeps track of what people try to bring with them into the hospital. The numbers are eye-opening.
The hospital averages seeing about 375 knives a month at the metal detector and about nine guns a year. Becker even tracks walkaways — the number of people who approach the metal detector and, for some reason, turn and walk away before entering the hospital.
That happens about 230 times a year, according to data Becker supplied.