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Hospital Emergency Departments

Starting a Hospital Security Risk Assessment

Posted on September 28, 2011 7:26 pm by Caroline Ramsey-Hamilton Comment

How to make sure your Security Department is Working for the Hospital.

Security Risk Assessment are not just Required by the Joint Commission – they are required in many states as a preventive measure to help prevent and reduce workplace violence.

The Risk Assessment also helps managers and administrators assess their security program, directly measure it’s effectiveness and helps determine
cost effective methods that can give you a great deal of protection for the lowest possible cost — something we call “bang for the buck”. 

The recent increase in violence comes as a surprise to doctors, nurses, managers and administrators, too.  Violence is not a concept that people usually associate with hospitals.  For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society.   However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.

 1.  Doctors are no longer thought of as “Gods”.  This means they are
      are more easily blamed when a patient’s condition deteriorates.

 2.  Hospitals are now regarded as businesses.  This perception has been
       been aggravated by television in shows like a recent “60 Minutes”, as well as
       by the effects of the recession on jobs and the loss of health insurance.

3.  Lack of respect and resources (funding) for hospital security departments
   .  Rather than being seen as a crucial protection for the hospital staff and
      patients, many security departments are chronically underfunded and used
      for a variety of non- security functions, such as making bank deposits for
      the hospital gift shop, driving the education van, etc.

The federal government  issued a guidance document for dealing with violence issues in healthcare,  called OSHA 3148.01R, 2004, Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers.  You can download a copy at www.osha.gov/Publications/osha3148.pdf



How to Correctly Analyze 100-Year Threats for Risk Assessments

Posted on September 25, 2011 2:40 pm by Caroline Ramsey-Hamilton Comment

Starting a risk assessment in northern Virginia and going through the threat list they say, “You can take earthquakes out – we don’t have earthquakes here”!

Hey, Haiti didn’t have earthquakes!

Vermont didn’t have major floods!

Connecticut doesn’t have tornados!

Like Murphy’s Law, as soon as you discount a threat, and think, “it will never happen here”, it happens!   The earthquake in the mid-Atlantic in August was a wake-up call for those who that they would never have earthquake damage.

One of the reasons that security risk assessment is so highly valued as an analytical took, and why it’s required by so many governments is because it DOES take into account the 100-year flood, the 75-year drought, etc.

Natural disasters can be so overwhelming, and catastrophic, that they must be considered in any proper risk assessment.  This is why some areas are not suitable for building housing tracts, because they are in a 100-year flood plan.

Because human memories are short, just because YOU haven’t experience a flood
along a meandering creek, doesn’t mean it will never happen.  

Always check the long-term probabilities when you start a risk assessment and make the numbers work for you!



Put your Hospital Security Department on a Low Fat Diet

Posted on August 11, 2011 12:55 pm by Caroline Ramsey-Hamilton Comment

Hospitals are reeling from potential losses in funding related to state budget cut-backs
and potential cuts in Medicare programs.  Every area of the hospital budget are being scrutinized, looking for areas to cut and reduce costs.

Instead of waiting for a memo about cuts that affect YOUR department, be a
pro-active manager and right-size your security department and show management
the changes you want to make.

It is possible to have an efficient, accountable security department without having costs run out of control.  It has to be based on real dollars, on real risks and it has to have the ability to show management WHY you need each element in your program.

The already-required risk assessment is the first start in this process.  When regulators come in to a hospital, they want to see the risk assessment first, and then they look to see if you followed the remediation plan identified in the risk assessment, which means they want to see you made the right improvements, based on the plan.

By including program elements in the risk assessment, and mapping it back to your actual budget, you can easily say that the Return On Investment is for each part of your program.



Workplace Violence Against Hospital Staff Discussed

Posted on May 19, 2011 2:14 am by Caroline Ramsey-Hamilton Comment

Just got back from a regional meeting of hospital security officers in Myrtle Beach. Aside from the T’storms every night – and the college kids shooting off bottle rockets, it was a great conference.

It reinforced my feeling that violence against hospital staff is one of the biggest challenges facing healthcare professionals. Vermont passed a law this week making violence against a healthcare worker a FELONY instead of just a misdemeanor. That’s progress, similar laws are being passed in other states, too. The governor of Vermont signed the bill on May 12, 2011. Congratulations to Vermont — they were first on this important issue.



Is Hospital Management Listening to Security Directors?

Posted on February 9, 2011 3:58 am by Caroline Ramsey-Hamilton Comment

Just finished a webinar yesterday to over 60 hospital security directors and managers and they later wrote in to say that their management listened politely to their suggestions, their budget needs, their warnings about the new violence levels — and then they said, “Thank you very much”, and went back to their paperwork.

We all know how tough it is to run a hospital, but when will the administration realize that violence in hospitals, whether it’s a distraught son, shooting his mother’s doctor in Baltimore, or a grief-stricken Chinese man running through a Shanghai hospital killing innocent bystanders with a knife — that we have a BIG PROBLEM with the increasing violence in hospitals.

The nurses know about the violence.  In a recent survey of 1000 nurses who worked in emergency departments, nurses reported that 97% experienced verbal abuse, 94% had physical threats, and 66% HAD BEEN ASSAULTED.  The saddest part of this was that 25% of the nurses said they expected abuse and violent attacks.

We need to devote some resources to this problem and not wait until 100% of nurses report assaults.  It starts with awareness that there is a problem. Tomorrow we’ll discuss the next steps.



Maine Hospital Fined by OSHA for Not Providing a Safe Workplace

Posted on January 31, 2011 3:54 am by Caroline Ramsey-Hamilton Comment

The Acadia Hospital in Bangor, Maine was fined $11,700 by OSHA (Federal Occupational Safety and Health Administration) on January 26th, 2011 for failing to provide a safe working environment for employees and improperly documenting workplace injuries.

They were referring to the fact that staff at the hospital had been subject to 115 attacks by patients between 2008 and 2010.  The report went on to say, “”The serious citation points to the clear and pressing need for the hospital to develop a comprehensive, continuous and effective program that will proactively evaluate, identify and prevent conditions that place workers in harm’s way,” said Marthe Kent, OSHA’s New England regional administrator.

OSHA’s report on The Acadia Hospital was at least partially the result of hospital officials making a policy decision to not use restraints on violent patients.   In fact,  Acadia Hospital’s CEO, David Proffitt, Ph.D., was very proud of this policy, saying in a published article in 2010,  “I want to share something I think is very exciting. The last mechanical restraint recorded at The Acadia Hospital was on June 21st, 2009.  This is a big deal.  We set a goal to end mechanical restraints and you have done so. It reflects a commitment to be the best at what we do.  And it gets better…… Our adult rate of restraint has been well below the national mean since May of 2009. . That means we are now in the top 3% of best performing hospitals!  I hope that fact inspires great pride in your self, your co-workers, and this hospital.  I know it does me!”.

Obviously, the no restraints policy wasn’t so great for the nursing staff!

Additionally, the OSHA report ordered the hospital to implement procedures to better protect staff, including screening patients for violent tendencies and offering more staff training on how to use physical restraints, though it did not specifically order the hospital to use them.

In the last eighteen months, OSHA has fined only a handful of hospitals for workplace violence-related incident, including Danbury Hospital, which had a homicide, and Oregon State Hospital in Oregon, which was fined in November 2010 for failing to give staff members self-defense training for dealing with violent patients.

According to The Statesman Journal,  OSHA fined the hospital $3,750 for violating three major safety violations:

  • Failing to provide timely training for staffers to use shields as “a tool to protect employees from projectiles, riots, and to approach patients in order to secure them.”
  • Not reporting to OSHA that a worker was hospitalized in late January after being assaulted by a patient.
  • Lack of written verification showing that a “hazard assessment” had been performed to ensure employees were provided with adequate personal protective equipment.

Looks like OSHA is gearing up to take workplace violence incidents more seriously in the future.   One of the backstories is that hospital employees talk to their unions, and the union leadership contacts OSHA on behalf of the employees.

The increasing problem with workplace violence in hospitals makes it absolutely imperative to start with a comprehensive program to combat and prevent workplace violence.



January 1st, 2011 Wake Up Call – Another Hospital Workplace Violence Incident.

Posted on January 3, 2011 4:47 pm by Caroline Ramsey-Hamilton Comment

My happy 2011 celebrations were marred by another workplace violence homicide in my home state of Maryland.   I guess it’s not always ‘the most – wonderful time of the year’!

This incident brings up again the question of how to keep our hospitals and their employees, safe in the new year.  In a recent Wall Street Journal article, they brought the hospital workplace violence problem up to a management level – reporting that many doctors now say they feel unsafe at work.

In upscale Bethesda, Maryland, just a minute north of Washington DC, a 40-year old male employee of Suburban Hospital (part of the Johns Hopkins Health System since July 2009), was found dead in a non-patient area of the hospital on January 1 at 10 a.m.

Here are the details (from the Suburban Hospital press release, from January 2, 2011):

Yesterday morning, a Suburban Hospital employee was assaulted in a non-patient-care area of the hospital.  Despite the heroic efforts of the hospital’s emergency response team, attempts to resuscitate the employee were not successful.  He died at the hospital as a result of traumatic injuries sustained to his upper body.

The victim has been identified as Roosevelt Brockington, Jr.  He was 40 years old and he had been employed at Suburban Hospital since August 2006.    Mr. Brockington was a Lead Engineer in the hospital’s Plant Operations Dept,   where he was responsible for operating and maintaining the heating, ventilation and air conditioning systems.

Because of the ongoing police investigation, no further information about Mr. Brockington is being released by the hospital at this time.  Suburban Hospital is fully operational today and remains open to patients and visitors.

This incident was a little different from some of the other incidents which have been in the news lately.   First, it was not an inner-city hospital, but instead, a hospital in a very affluent area.  In fact,   Bethesda is one of the most affluent and highly educated locales in the country, placing first in FORBES list of America’s most educated small towns and eleventh on CNNMoney.com’s list of top-earning American towns.

Another difference was that it occurred in mid-morning – 10 a.m., not late at night. News reports about the incident surmised that it was not patient-related, but no one really knows at this early stage in the investigation.

 The victim, Roosevelt Brockington, Jr., was a resident of Lusby, Maryland.  For those who aren’t familiar with Lusby, it is a small town of less than 3,000 people in southern Maryland, over 70 mile commute from Bethesda. 

Having been to over twenty hospitals in 2010, I am struck by the difference between the northern east coast hospitals and the south Florida hospitals.   Many of the hospitals in south Florida have effective visitor management systems in place.  I visited a hospital in Florida just before Christmas, and they had the local choir singing carols in the background, while I took out my drivers license, had my photo taken, and received a visitor’s badge.

There seems to be a mind set in some of the northeast hospitals against trying to manage visitors.  This includes a lack of metal detectors, and a lack of visitor sign-in procedures.  I wonder if this is a cultural attitude – because many of the north east hospitals are older than their south Florida counterparts and may be more entrenched in their attitudes. 

The epidemic of workplace violence in hospitals is only starting to gain national attention since the Journal of the American Medical Association published a research paper on the increase in violence in U.S. hospitals in December 2010, and included the statistics from

The Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, summarizing Bureau of Justice Statistics data, estimate 1.7 million injuries per year due to workplace assaults, accounting for 18% of all violent crime in the United States and the rate of workplace violence in healthcare setting is about 4 times the national average.

There are a plethora of workplace violence prevention strategies that can be put in place and maybe this New Year’s Day wake up call will result in every hospital examining their Workplace Violence Prevention plans.



JOHNS HOPKINS HOSPITAL MURDER/SUICIDE IS TOO CLOSE TO HOME!

Posted on September 17, 2010 3:16 am by Caroline Ramsey-Hamilton Comment

My summer vacation is over so I jumped right back into work by doing four webinars on workplace violence in the last four days.   I have been very concerned about the trend toward violence toward healthcare and hospital workers.

Having just researched and presented on this subject two days ago, I was greatly saddened to see it AGAIN, 30 miles from my home, at the prestigious Johns Hopkins Hospital.   Local media and CNN covered it extensively because the man shot his mother’s doctor in the stomach, apparently after his mother was paralyzed as a result of spinal surgery.  He then barricaded himself into his mother’s hospital room and eventually shot and killed her and then shot himself.

With a staff of over 30,000,  this was a major incident.  I would love to calculate how much the hospital might have lost from having the staff vacate the building for at least two hours.

This incident once again opens the debate about how to ‘secure’ hospitals, or at least to have a better way to ensure the safety and security of both the staff and the patients.  Hospital administrators continue to maintain an ‘open environment’, and don’t seem to understand that this problem will continue to increase, if there is not way to better manage access in hospitals.

On the radio today, I heard that Baltimore City Council President Bernard C. “Jack” Young said that John Hopkins security is adequate and that using metal detectors would create a hazardous situation for patients entering the building.   “Why would they want metal detectors going into the hospital?” Young said. “People go to the hospital because they got shot. People wouldn’t go to the hospital because of the metal detectors. They would stay away and die rather go through metal detectors.”  He also mentioned during the same interview that the hospital has over 80 entrances.

This exact problem is raging at hospitals all over the country, because violence is dramatically increasing in healthcare.  The NIOSH study from 2004 reported that  violence in hospitals was over four times the national average for non-healthcare workplaces.  Of course, it is now 2010 and that is a long way from 2004 – AND – we have had a terrible recession raging since 2008….

The results of an Emergency Nurses Association survey released in 2009 found that more than 50% of ER nurses had experienced violence by patients on the job and more than 25% had experienced 20 or more violent incidents in the past three years. Research showed long wait times, a shortage of nurses, drug and alcohol use by patients, and treatment of psychiatric patients all contributed to violence in the ER. 

There has been only sporadic interest in this phenomenon and no standard has emerged.  For example, a NIOSH (National Institute for Occupational Safety and Health) Publication in 2004 is called Guidelines for Preventing Workplace Violence for Health Care and Social Services . OSHA Publication 3148-01R (2004). This guide describes the special considerations surrounding workplace violence in the environments of health care and social services.

After my last column on Workplace Violence issues in healthcare, I got a few angry letters from associations and organizations saying they had been working on creating standards for this – FOR THE LAST FOUR YEARS… but amazing, they have not been published.  

There is NO standard or requirement for preventing workplace violence, only the vague requirement for employers to maintain a safe workplace.   Twenty-seven states have come up with their own ‘guidelines’.  Remember – standards are Required, guidelines are only recommended.  That means if the incident happens, the management has no liability because they did not disregard a requirement.

My regular readers will remember that I recently visited a hospital that had a murder about two years ago and even two years later, it was still having a traumatic impact on the staff who witnessed the incident. 

I am a big believer in risk assessments and I think having a workplace violence assessment REQUIRED of every hospital, and having that information aggregated nationwide and studied, would be a big step that improve our knowledge of why this continues to increase, and would also point to more effective solutions to safeguarding our hospitals.

Maybe people will start to press hospitals on this issue – after all – they may end up in a hospital some day, and probably would like to be safe and secure during their visit.

Maybe the aging baby boomers will finally demand more security in their hospitals.  I hope so.



Want to see MY Medical Records?? No Problem.

Posted on February 15, 2010 6:25 pm by Caroline Ramsey-Hamilton Comment

The fury and passion devoted to protecting medical records is totally incomprehensible to me. 

Who wouldn’t want their med records to be immediately available in case of  an emergency?   I have a twinge ( as opposed to a tweet) every time I go to my doc’s office and see his color-coded manila folder filing system.  It is a nightmare, but it doesn’t seem to bother the nurses.  

I understand that if someone had AIDS, they might not want their boss to know about it. But how many people reading this have AIDS (3/100 ths of a percent), based on U.S. Census Data (309 million Americans) and number of Americans afflicted (1 million). So could not be the only reason. 

I understand why not to disclosure STD’s.   What else?  I thought about my medical record and how bare and boring it is.   I’ll be happy to tell you all about it.  Here are the highlights:

     Had Scarlet Fever when I was about 11 years old.  I was lucky – no side effects, but my sister lost her hearing in one ear.

     Broke my right ankle in ballet class when I came down on the wrong angle after a SPECTACULAR tour jete!  I’m proud of that one.

     Got kicked by a pony near my left ankle when I was in my 40s.  Didn’t break anything, but insurance company put MY ANKLE on the list of NON-COVERED areas. LOL

    One dog bite from a German Shepard when I was college.  It was an accident.
    We were playing grab-it with a toy…

     Used to get bronchitis fairly regularly when I smoked, which was over twenty-five years ago.

     Had tubes tied after 2nd son.

     Had an eye lift – cosmetic surgery – Hurrah….

Pretty scintillating stuff!   You can see why I don’t worry about anyone getting their hands on my medical records.    I don’t even care about any of this – why would anyone else?  

I got another view of the medical record problem when my sister was diagnosed with a brain tumor.  HER medical records were enormous and included things I had never seen before like 3-D rotating images of her brain so doctor could turn it around and view it from any angle.  Her records were so complex that we literally had to take a set of CD’s to office visits.  Didn’t make any difference, she died four months later.

The cost of converting my boring records is something else I wanted to check out.  For a small doctors office with 3 doctors – installing a full document management system would cost about $100,000 with an annual maintenance fee of $30-50,000.  Quite an initial investment for a small office.

Here are some fun stats on paper records, from a Coopers Lybrand survey on the time and money spent on paper in today’s typical organization:

• Of all the pages that get handled each day in the average office, 90 percent are merely shuffled. 

.   The average document gets copied 9 times. 

• Companies spend $20 in labor to file a document, $20 in labor to find a misfiled document, and $220 in labor to reproduce a lost document.

.  7.5 percent of all documents get lost, 3 percent of the remainder get misfiled.  

• Professionals spend 5-5 percent of their time reading information, and up to 50 percent of their time looking for it.  

• There are over 4 trillion paper documents in the U.S. alone – growing at a rate of 22 percent per year. 

The famous Google Health project will digitize your medical records and put it in their repository for free, BUT you have to get them from your doctor in digital form first. 

And to see how mainstream this concept is going – there’s now an App for that! Yes, if you have an iphone you can get Health Cloud for free!  

But now that I have published my medical records on Twitter, or at least, my summary of my medical record – the whole world can have access!



Searching for Hard Data about Security Cameras…

Posted on February 3, 2010 5:00 am by Caroline Ramsey-Hamilton Comment

I was really surprised when someone asked me about how many cameras should be put in a small hospital to deter violence against healthcare workers. They were asking for a universally recognized guideline or standard that would give them ammunition to take to management to prove why they needed the extra cameras installed in the Emergency Department.

If you’re already in either the security or healthcare field,  I’m sure you’re aware of the dramatic increase in violence against healthcare workers and why this is obviously a concern of all healthcare facilities.   Cameras are often the first stop in a security improvement program because they provide a lot of visibility/protection at a reasonable cost.  

My next step was to start looking through different standards to see if there was a standard for how many cameras should be in an Emergency Department, or a birthing center, or a hospital lobby.  I could not find a simple standard anywhere.  I first started looking at FEMA requirements for preventing terrorism (FEMA 428) (www.fema.gov) and while they covered lighting, they stopped short of recommending a basic configuration, or an “acceptable minimum” for cameras.  Next I looked at the International Association for Healthcare Security and Safety (www.iahss.org) and they also mentioned lighting and cameras but again, without specific guidelines for the various parts of a hospital.

More research followed.  I called about a dozen hospital security directors, and then started on a literature search.  I started with the classic Russell Colling book, “Hospital and Healthcare Security” and again found a great deal of common sense advice and recommendations on how cameras should be placed to view certain areas and the panning area, and what kind of cameras to use where, but again, no exact direction on how many cameras should be put in a hospital emergency department.

Back to the phone to get more information, I talked to more security professionals who explained that each facility is different — each hospital is different — each hospital has a different budget — different configurations.   I totally understand that companies that sell cameras and lighting to hospitals (and all sorts of other facilities) want to do an in-depth assessment before each installation to make sure the cameras fit the total security picture. 

But I think that the security organizations should start creating minimum standards with actual guidelines of WHAT KIND, HOW MANY and WHERE To INSTALL, as a sort of default value, or minimum to achieve some level of improved security.  For example, ‘basic’ or ‘minimum’ recommendation for an ED might be — one camera at each entrance and exit and a camera at the admissions area.  Having some basic configurations spelled out would be a great thing for security directors and probably for the camera companies.

Those who have read my blogs before know I am a big proponent of standardization — for lots of reasons.  It is good for the buyers because they don’t have to agonize over whether they are getting a certain (if minimal) level of protection; and it helps them secure the budget to install the new camera systems.  It’s good for the camera integrators because it increases sales because (see previous sentence), security departments can more easily get budgets approved and thus, sell more camera systems.

One of the security groups I talked to told me that the reason they don’t have a minimum is because it reduces pressure on smaller organizations that may not be able to afford a particular system, but I think that with the increasing use of cameras, having a minimum standard makes sense and would be a win-win proposition for everyone.

For example, did you know that rail gauge on railroad tracks used to be different for every state?  So early trains could chug around a state, but couldn’t cross the border into another state because the rail gauge was different.  After the rail gauge was ‘standardized’ so that the whole country used the same gauge of track — trains were going coast to coast and everywhere in between.  It allowed rail travel and shipping by rail to really take off.   Maybe we can do the same with cameras.




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