Violence in the ASC Setting A case study based on experience BY BETH CHRISMER


Hospital emergency rooms deal with potentially violent, aggressive patients and fam- ily members almost daily. In the ASC setting, we are


not well-prepared to handle this type of an event. Our ASC experienced a ran- dom act of violence, and I will discuss workplace violence in the ASC setting at ASCA 2016, May 19–22, in Dallas, Texas. Our center had an event on Novem- ber 26, 2013, that led to two people being killed and three injured. One of the two killed was one of our nurses. During my presentation, I will help you understand the factors that con- tribute to an increased incidence of armed violence in health care settings, recognize risk factors and behaviors that indicate potential for violence and talk about how to prepare for an armed assailant event in the ASC setting. The day our world changed, a patient came to our facility for a procedure accompanied by her son. She was taken in for her procedure and her son was escorted to the lobby where he inter- acted with the other visitors. Then he went to the bathroom, came out wielding a knife, went on a rampage and stabbed five people: two of our employees and three visitors. We had a heroic nurse who came forward and was stabbed to death when she tried to stop him from coming to the clinical area. He contin- ued in and went out through the back door. He was apprehended seven min- utes after he left the center and the whole act took three minutes. All five assaults happened within 30 seconds. This random act of violence, essen-


tially, changed the way we operate. We kept asking what we could have done to prevent this. Even if we had an armed police officer in the lobby, it is doubtful that we would have been able to stop the


initial act. We do not have metal detec- tors and we do not check for weapons. This is neither the standard for ASCs nor is it conducive to the friendly and welcoming environment that we strive to foster. We have signage that says “no guns,” but you do not know what some- body has in their pocket. As a health care facility, we find it challenging to have a secure facility and an open and welcoming center for our patients and visitors at the same time.


In the immediate period after the


event, we provided emergency care to the victims and our staff, implemented


a command center, cooperated with law enforcement, managed media requests, offered support and counseling to our staff and the families of victims and reported to the appropriate regulatory agencies. The challenging part came later. The healing of our 75 employ- ees is ongoing. Emotional trauma from this random act of violence exists even today. We face each day with the resolve to care for our patients in the safest environment we can offer. In 2013, there were 5,710 cases of violence in private hospitals according to the Bureau of Labor Statistics but


ASC FOCUS APRIL 2016 9


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