Residents' Experiences of Abuse and Harassment in Emergency Departments.

The widespread epidemic of emerging abuse in Emergency Departments (ED) toward residents generates negative effects on the residents' health and welfare. The purpose of this study was to determine and highlight the high prevalence of abuse and harassment toward Emergency residents. In 2011, a multi-institutional, cross-sectional study was conducted at seven Emergency Residencies of central hospitals in Iran. Residents were asked about their age, marital status, postgraduate year (PGY) levels, and work experiences before residency. Prevalence of abuse in four categories was evaluated: verbal abuse; verbal and physical threat; physical assault and sexual harassment; and by whom. The data were analyzed by SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Two hundred fifteen of the 296 residents (73%) completed the survey. The prevalence of any type of abuse experienced was 89%; 43% of residents experienced verbal and physical threats, 10% physical assault, and 31% sexual harassment. Verbal abuse and verbal and physical threats without the use of weapons were higher in men in comparison with women ( p< .04). Women were more likely than men to encounter sexual harassment (31% vs. 7%, p< .01). Among the sexual harassment categories, sexual jokes (51%) were the most prevalent between residents. Junior residents (PGY-1) were more likely to experience abuse than senior residents (PGY-2 and PGY-3; p< .01). Patients and their companions were the main agents of abusive behaviors. Abuse and harassment during residency in ED are highly prevalent. Educational programs and effective preventive measures against this mistreatment are urgently required.

Cause of Emergency Department Mortality; a Case-control Study.

INTRODUCTION: Based on previous studies, cardiovascular diseases, traffic accidents, traumas and cancers are the most important etiology of mortalities in emergency departments (ED). However, contradictory findings have been reported in relation to mortality in emergency departments. Therefore, the present study was undertaken to evaluate the role of clinical factors in mortality among patients referring to an emergency department in a third-level hospital in Tehran, Iran. METHODS: In the present case-control study, all the patients over 18 years of age were evaluated, referring to the ED of Imam Hossein Hospital, Tehran, Iran, from the beginning of 2009 to the end of 2010. The patients died in the ED were placed in the case group and those discharged or hospitalized in other hospital wards in the control group. Demographic data, background diseases, and the final diagnoses were recorded. Chi-squared test, multivariate logistic regression, and Pearson's correlation coefficient were used to evaluate the relationship between the variables mentioned above and patient mortality. RESULTS: 2907 patients (969 (59.9% male) in the case and 1938 (62.2% male) in the control groups) were evaluated. Cardiovascular diseases (39.2%), severe traumas (18.5%), and cerebrovascular accidents (17.7%) were the most frequent etiology of patient mortality in ED. Multivariate regression analysis showed that presentation with cardiovascular complaints (OR=7.3; 95% CI: 3.5-16.1; p<0.001), a history of hypertension (OR=5.4; 95% CI: 1.2-12.3; p<0.001), severe trauma (OR=4.6; 95% CI: 2.0-13.2; p<0.001), age over 60 (OR=3.8; 95% CI: 1.8-7.8; p<0.01) and a final diagnosis of renal disease (OR=3.4; 95% CI: 2.1-6.4; p<0.001) were factors that increased the odds of mortality in patients referring to the ED. Multivariate regression analysis in patients over 60 years showed that sepsis was an independent factor increasing the risk of death (OR=2.9; 95% CI: 1.3-5.9; p=0.009). A patient's risk of death increases with an increase in the number of risk factors in that patient (r(2)=0.96; p=0.02). CONCLUSION: It appears the odds of mortality in patients referring to ED with cardiovascular complaints, a history of hypertensive, severe trauma, age over 60 and a final diagnosis of renal disease are higher versus other patients. In addition, the patients' odds of death increase with an increase in the number of risk factors. Such an increase is more noticeable at age over 60.

Residents' experiences in dealing with abuse in emergency department: a survey in Iran hospitals.

BACKGROUND: Abuse in Emergency Department (ED) as a widespread phenomenon, has negative effects on ED residents. This issue pertains to Western as well as Asian countries. OBJECTIVE: The purpose of this study was to assess how Iranian ED residents deal with abuse. Awareness, educational programmes, reports, causes of abuse and ways to reduce this were considered in this survey. METHOD: In 2011, a cross-section survey was conducted at seven ED residencies of central hospitals in Tehran, Mashhad, Ahwaz and Tabriz. ED residents were asked about their age, sex, abuse time, awareness of abuse, educational programmes, reporting abuse, causes of reluctance to report, and how to reduce abuse. The data were analysed by SPSS V.20. RESULTS: A total of 215 questionnaires were completed. Abuse was reported to have occurred most frequently during night shifts (n=89, 41.4%),  and most of the residents were abused by men rather than women (n=132, 61% vs n=22, 10%, p<0.05). About half the residents (n=107, 49.8%) were not aware of any abuse. Only 22% (n=46) had formal or informal education in abuse, and 74% (n=158) of them had not gone through any learning programmes. Most residents (n=175, 81%) did not know how to report abuse, and among respondents, most of the residents did not report the abuse (n=86, 40%), and the cause was mostly the uncertainty towards officials being able to solve the problem of abuse (n=67, 38%). Residents most often reported not to admit patients more than the hospital's capacity as the main solution to reduce abuse (n=61, 32%). CONCLUSIONS: Being abused during residency is a universal problem, and there is a lack of awareness and the knowledge of how to deal with abuse, and reporting it among ED residents in Iranian hospitals.