[Emergency care as a high-risk workplace-Measures to deal with violence against employees]. / Notfallversorgung als risikoreicher Arbeitsplatz ­ Maßnahmen zum Umgang mit Gewalt gegen Beschäftigte.

BACKGROUND: Many employees in the field of emergency care experience verbal and physical violence caused by patients or visitors. The aim of this project is to gain insights into which measures are available to deal with violence in emergency care and how employees subjectively evaluate them. METHODS: A nationwide cross-sectional online survey was conducted in 2020. The questionnaire contained items on violence prevention, intervention, and follow-up measures. Quantitative data were analysed descriptively and free text data according to Mayring's qualitative content analysis. RESULTS: A total of 349 respondents, including 115 supervisors participated in the survey. The availability of security staff and standardised reporting of incidents were considered important measures for dealing with violence. Of the managers, 67% reported not having a security service, while 56% claimed that reported incidents of violence were not dealt with in a structured way. A high workload in emergency care can impede the implementation of measures. Overall, the demand for increased support by supervisors and the hospital management became clear. CONCLUSION: It is evident that employees consider certain measures to be effective; however, these measures are often not consistently implemented. There is a need for structured reporting of violent incidents against employees to facilitate a realistic recording of the prevalence. In addition to increasing the (nursing) staff, restricting access for visitors can decrease the conflict potential.

Risk of Burnout among Emergency Department Staff as a Result of Violence and Aggression from Patients and Their Relatives.

Emergency department staff are often affected by incidents of violence. The aim of the study was to generate data on the frequency of violence by patients and accompanying relatives and the correlation between experienced aggression, a possible risk of burnout and a high sense of stress. Additionally, the buffering effect of good preventive preparation of care staff by the facility on aggressive visitors and patients was examined. In this cross-sectional study, members of the German Society for Interdisciplinary Emergency and Acute Medicine were surveyed. The investigation of risk factors, particularly experiences of verbal and physical violence, as well as exhaustion and stress, was carried out using ordinal regression models. A total of 349 staff from German emergency departments took part in the survey, 87% of whom had experienced physical violence by patients and 64% by relatives. 97% had been confronted with verbal violence by patients and 94% by relatives. Violence by relatives had a negative effect on perceived stress. High resilience or effective preparation of employees for potential attacks was shown to have a protective effect with regard to the burnout risk and perceived stress. Therefore, management staff play a major role in preventing violence and its impact on employees.

Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study.

OBJECTIVES: Thoracic trauma (TT) is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. Its management is still a very challenging task. The purpose of this study was to analyse the risk factors affecting the outcome in a high-volume trauma centre and the efficacy of a specialised trauma team in level 1 trauma centres. PATIENTS AND METHODS: Between January 2003 and December 2012, data of all patients admitted to the accident and emergency (A&E) department were prospectively collected at the German Trauma Registry (GTR) and thereafter retrospectively analysed. Patients with chest trauma, an Injury Severity Score (ISS) ≥ 18 and an Abbreviated Injury Scale (AIS) > 2 in more than one body region were included. Patients were divided into two groups: group I included patients presenting with thoracic trauma between January 2003 and December 2007. The results of this group were compared with the results of another group (group II) in a later 5-year period (Jan. 2008-Dec. 2012). Univariate and multivariate analyses were performed, and differences with p < 0.05 were considered statistically significant. RESULTS: There were 630 patients (56%) with thoracic trauma. A total of 540 patients (48%) had associated extrathoracic injuries. Group I consisted of 285 patients (197 male, mean age 46 years). Group II consisted of 345 patients (251 male, mean age 49 years). Overall 90-day mortality was 17% (n = 48) in group I vs. 9% (n = 31) in group II (p = 0.024). Complication rates were higher in group I (p = 0.019). Higher Injury Severity Scores (ISSs) and higher Abbreviated Injury Acale (AIS) scores in the thoracic region yielded a higher rate of mortality (p < 0.0001). Young patients (< 40 years) were frequently exposed to severe thoracic injury but showed lower mortality rates (p = 0.014). Patients with severe lung contusions (n = 94) (15%) had higher morbidity and mortality (p < 0.001). Twenty-three (8%) patients underwent emergency thoracotomy in group I vs. 14 patients (4%) in group II (p = 0.041). Organ replacement procedures were needed in 18% of patients in group I vs. 31% of patients in group II (p = 0.038). CONCLUSIONS: The presence of severe lung contusion, a higher ISS and AISthoracic score and advanced age are independent risk factors that are directly related to a higher mortality rate. Management of blunt chest trauma with corrective chest tube insertion, optimal pain control and chest physiotherapy results in good outcomes in the majority of patients. Optimal management with better survival rates is achievable in specialised centres with multidisciplinary teamwork and the presence of thoracic surgical experience.