As staff recruitment and retention remain major challenges in the healthcare industry, how can healthcare organizations ensure staff members feel safe in their work environments? This question has been a driving force behind design conversations in recent years.
He Bureau of Labor Statistics Reports that the injury rate from violent attacks against medical professionals increased by 63 percent between 2011 and 2018, and hospital security directors say assaults against staff increased as the COVID-19 pandemic intensified in 2020.
In a 2022 survey conducted by United National Nursesthe nation’s largest registered nurses union, 48 percent of the more than 2,000 nurses who responded reported an increase in workplace violence, more than double the percentage from the previous year.
Previously, safety considerations were largely limited to behavioral health units. However, due to the increase in mental health problems and violence in the general population in recent years, stronger safety considerations, including improved room designs, are now a pressing need in all hospital and clinic areas. examination and greater visibility.
Security strategies for healthcare facilities.
According to the Occupational Safety and Health Administration (OSHA)Potential sources of violence in hospitals, nursing homes, and other healthcare settings include verbal threats or physical attacks by patients, distraught family members who may be abusive or even become active aggressors, gang violence, domestic disputes that spill over into to the workplace and harassment of co-workers.
To prepare and protect healthcare staff from agitated or irritated patients and visitors, below are some essential design elements to consider on healthcare campuses, including exam rooms, emergency departments, and nursing stations.
Exam rooms: Starting with the exam room, design strategies should always carefully establish patient and staff positioning at the entrance. There should be a clear exit path for staff and patients should never be able to block a staff member’s path to the door.
Staff members should also have access to charts or computers without their backs to patients. This helps reduce surprises and allows staff members to be aware of their surroundings.
In some cases, a second exit point may be considered on the opposite side of an exam room for added security, so that if the patient were to block an exit in the room, there is another door for staff to retreat to, if it is necessary. This strategy is especially used in emergency departments where there may be a higher volume of patients who may become agitated.
Emergency Department: When designing emergency departments (EDs), any area where a staff member has first contact with patients requires increased safety considerations until the patient safety risk can be assessed. For example, patients may receive initial treatment in triage rooms where adrenaline may be elevated. Providing a second means of egress in an opposite location in the room is one way to increase safety measures, if possible.
In addition, the nursing station, which must be in an area with visibility for patients and visitors. Project teams should also strategically place campus security desks in visible areas to keep security personnel nearby if a situation were to arise, particularly during the evening and night hours.
Technological measures: Security cameras in waiting rooms and reception areas, along with an accessible duress button to use if circumstances worsen and a patient becomes aggravated, are key strategies to consider. Technological improvements at ED entrances and check-in areas can also provide an additional level of security, including metal detectors and cameras in lobbies and behind the reception desk to allow for better surrounding awareness.
Lock buttons are now a necessity to secure the main entrance if an attacker is known to be coming or if there are additional irritated visitors. Green code buttons provide additional support by alerting security to any issues. Security staff can then quickly go to the cameras to see where help is needed and get people in or out.
Consultation rooms: Patient services and consultation rooms should allow some privacy for confidential conversations. To create a sense of transparency and security, interior windows or glass panels can be used to give other nearby staff the ability to observe staff-patient interactions and provide backup if necessary.
As in other areas, staff should be able to see computers without their backs to patients, and there should be a clear exit path along with a duress button in case of emergency.
Entrances and lobbies of healthcare facilities: There are many design considerations to shield the clinical area from view of the lobby so that the area remains safe in the event of an active shooter or assailant. Starting with the main entry sequence, the registration area and main entry points must be protected from unwanted intruders. The reception desk should be strategically located in a highly visible location with access to the back of the house.
Additionally, visitors and patients should not be able to walk behind the reception desk or in any part of the facility that provides them with a direct link to staff or clinical areas.
The reception desk can be protected with doors, card readers and, in some cases, additional security glass, with a separate door outside the space to easily get staff to safety without having to enter the lobby.
The ability to close off the back of the house and provide staff in the lobby with a safe exit if the rest of the building is closed are also important considerations.
Strengthen security on campus
Preparing for situations with agitated or irritated patients and visitors is essential to create proactive buffers against active and potential threats.
Design considerations such as multiple exit routes, duress buttons, and locking capabilities are just a few of the many ways to strategically approach healthcare campus security planning.
Sara Malin is a healthcare architect and director of World Architects and Engineers (St. Paul, Minn.) and can be reached at smallin@woldae.com. Andrew Jordan is a healthcare planner and principal at Wold Architects & Engineers (St. Paul) and can be reached at ajordan@woldae.com.
For more information on this topic, read “Design for staff safety in healthcare facilities.”
