स्वास्थ्य देखभाल संचार जर्नल खुला एक्सेस

अमूर्त

Patient Agitation and Violence in Medical-Surgical Units at a Large Inner-City Community Health Center in New York, One Year Before and During the COVID-19 Pandemic

Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Vicente Liz, Jose Tiburcio, Douglas Reich

Importance: Institutional violence has a grave burden on the healthcare system and has a major impact on staff’s physical and mental wellbeing. The COVID-19 pandemic has brought to bear the complexity of circumstances, which may have increased its incidence.

Objective: To determine whether the prevalence of agitation and violence in medical-surgical settings increased in BronxCare Hospital (BCH) during the COVID-19 Pandemic.

Design: This is a retrospective study to identify the effects of the COVID-19 pandemic in increasing patient agitation and violence in medical-surgical settings in BCH. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two-time frames: Pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021).

Participants: Four exclusion criteria were determined:

• Subjects under 18 years old;

• Agitation or violence related to substance use or withdrawal from substances or certain medications such as benzodiazepines;

• Agitation due to delirium and dementia;

• Verbal agitation and threats that were redirected and managed without the use of restraints or medications.

Results: The sample size for the pre-COVID-19 population was n=115, while the sample size for the COVID-19 timeframe was n=194. The ratio between age groups remained the same for both timeframes. During COVID-19, there was an increase in female patients (n=65, 33.5%) and a decrease in male patients (n=129, 66.5%). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 periods. Our data shows that there was an increase of almost 70% in incidents of violence during COVID-19 (03/2020-03/2021) with 194 (62.8%) reported events, compared to pre COVID-19 (03/2019-03/2020) with 115 (37.2%) events (p=0.01).

Conclusions and relevance: Agitation and violence increased in medical-surgical settings at BCH during the COVID-19 pandemic.

Our data can potentially improve the quality of care and safety for healthcare workers and patients by using preventative approaches and the least restrictive measures when dealing with agitated patients. Updating policies and reviewing the protocols for safety in the healthcare system need to be considered during future large-scale events such as the Pandemic.