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Managing disruptive patients in health care: Necessary solutions to a difficult problem

Authors

  • Michael J. Hodgson MD, MPH,

    1. Occupational Health, Office of Public Health, Veterans Health Administration, Washington, District of Columbia
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  • David C. Mohr PhD,

    Corresponding author
    1. Center for Organization, Leadership and Management Research, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts
    2. Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
    • Center for Organization, Leadership and Management Research, VA Boston Healthcare System (152M), 150 South Huntington Ave, Boston, MA 02130.
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  • David J. Drummond PhD,

    1. Department of Psychiatry, Oregon Health Sciences University, Portland, Oregon
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  • Margaret Bell RN CIC,

    1. Patient Care Services,Veterans Health Administration, Milwaukee,Wisconsin
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  • Lynn Van Male PhD

    1. Behavioral Threat Management Program, Occupational Health, Office of Public Health, Veterans Health Administration, Washington, District of Columbia
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  • Disclosure Statement: The authors report no conflicts of interests.

  • Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Abstract

Background

We sought to describe the components and processes in a violence risk assessment and management system, including electronic record requirements in the Veterans Health Administration (VA). We present information on system-level variation among program elements and their association with perceived and measured effectiveness.

Methods

We conducted a cross-sectional survey of Chiefs of Staff (COS) at 140 VA hospitals across the United States about specific disruptive behavior program elements, such as committee processes, patient referrals, and outcome patterns. We assessed COS perceived effectiveness of the processes. We compared COS perceptions with employee-reported assault-related incident rates and workers compensation lost time claim rates for assault-related injuries for 2009 and 2010.

Results

We found the violence risk assessment and management system is heavily used, often with guidance to provide police protection for providers. COS respondents were generally satisfied with design and performance of the system. Committee processes and perceptions of effectiveness were associated with reduction in assault-related incident rates.

Conclusions

VA's system was considered effective by system owners and users may be effective at reducing assaulted-related injuries. Am. J. Ind. Med. 55:1009–1017, 2012. © 2012 Wiley Periodicals, Inc.

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