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LONG BEACH, Calif. -- A Pittsburgh-based hospital system has seen a rapid decrease in violent attacks by mental health patients against staff members, a psychiatric nurse told colleagues here.

From 2020 to 2021, reported violence at Allegheny Health Network facilities fell by 20%, and reported cases of staff being struck by combative patients dropped by 29%, reported Jamie Elyse Malone, MSN, RN, during a presentation at the American Psychiatric Nurses Association annual meeting.

These improvements are likely due to a series of strategies such as emergency response teams, the flagging of violent patients, and crisis intervention training, she noted.

"We've seen really positive results from all these different initiatives," Malone said. "We can't say there's causation from the data, but it looks like they really work."

Any reduction in workplace violence against healthcare workers would make Allegheny Health's hospital system an outlier. According to a by the Joint Commission, "U.S. healthcare workers in the private sector are 5 times more likely to experience nonfatal violence-related injury compared to workers in all other private industries combined."

Violence rates at general hospitals have doubled since 2011, and "overall, nearly three-quarters of all violence-related nonfatal injuries and illnesses in 2018 were incurred by healthcare workers," the report noted.

While data are sparse, have also that violence against healthcare workers has increased during the COVID-19 pandemic.

A 2018 survey of 990 Allegheny staff members found that only 24% said they reported cases of workplace violence, with 74% reporting that they were instructed to do so. Only 11% said they felt prepared to deal with aggressive/violent behavior. "We realized that we needed to change in order to better protect our team members, patients, and visitors," Malone said.

Subsequently, the hospital system developed a centralized police force with sworn officers, and spent the next several years developing other strategies to address violence.

Crisis response teams are now in place and led by clinicians with de-escalation training. Depending on availability, the teams can include security/hospital police, behavioral health staff, physicians, and hospital managers. In addition, "crisis response bags" are available that include tools such as "hard" restraints with keys, bite sleeves, spit masks, and towels, Malone added.

However, the protocol only calls for crisis teams to respond in the most severe situations, she noted. "Sometimes somebody might be yelling, they might be acting up a little bit, so you call the whole team to help and it just escalates the situation more," she explained. "So we have four levels in our crisis response, which helps us get the appropriate response."

The full crisis teams only respond at the highest two of the four levels when patients actually become physical/violent. "If there's a threatening act -- somebody with an IV pole trying to break a window, somebody's trying to strangle a nurse -- our police and security are trained to get into that room as quickly as possible," she said.

Debriefing and reporting are important parts of the protocol, Malone noted, and have led to administrative action. "Because you reported that incidences of delirium have gone up, and they've caused 50% of our violent offenses in the last month, we've set up this whole program to help prevent delirium. That is the way we get staff to actually report -- by being transparent with the data and letting them know how that has driven our initiatives and our processes to make things better," she said.

Over the last 4 years, Allegheny Health has also created councils and committees devoted to preventing workplace violence, added metal detectors to emergency department entrances, conducted simulations, and adopted a violence prediction tool that provides risk notifications.

Patients at risk of being violent are now flagged in the EPIC system, Malone noted. "We wanted to make sure we very clearly but subtly communicated with our staff when a person is likely to become violent."

Personal panic alarms are now available for staff members, along with specially designed pens and toothbrushes that prevent injury when wielded by a violent patient.

Over 3 years, more than 3,000 staff members were trained in de-escalation techniques, Malone reported, and evidence suggests that "calls for a crisis response appeared to decrease incidents of reported injury from violence."

What's next? Malone said she's working on ways to keep hospital leaders focused on preventing workplace violence instead of letting their attention wander to other projects. "I also would really like to see us do a little bit better with reporting and find out how we can do more projects to continue to prevent violence. One of the big specialty projects that we hope to work on next is alcohol withdrawal. It's a struggle at our hospitals, and we can do a lot better."

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