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La violence dans les services d’urgences : évaluation d’une politique de réduction de la violence dans un service d’accueil des urgences parisien

Violence in the emergency department: Evaluation of a policy to reduce violence in one university emergency department in Paris area

  • Article Original / Original Article
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Annales françaises de médecine d'urgence

Résumé

Introduction

Les violences au travail (VT) sont très fréquentes en milieu de soins et particulièrement aux urgences, leur réduction est donc une priorité. Néanmoins, aucune étude évaluant l’efficacité des politiques de réduction des VT n’est disponible. L’objectif de notre travail est de présenter les résultats de la stratégie de réduction des VT conduite dans notre service d’accueil des urgences (SAU).

Méthode

Le projet d’amélioration continue de la qualité mis en place dans notre SAU à partir de 2006 a eu comme objectifs d’améliorer les conditions d’accueil des patients, la sécurité des patients et du personnel, de lutter contre la maltraitance et de développer la bientraitance des patients, et de réduire le nombre de VT. Pour mesurer l’impact du projet qualité, nous avons mesuré l’évolution des indicateurs entre 2006 et 2014: temps d’attente médecin, temps total de passage, nombre de VT déclarées par le personnel, nombre d’interventions des équipes antimalveillance, absentéisme du personnel et satisfaction des usagers.

Résultats

Pendant la période d’étude, nous avons constaté une diminution significative (p<0,001) de la durée totale de séjour et du délai d’attente médecin, du nombre de VT déclarées et du nombre d’interventions des équipes antimalveillance au SAU et de la satisfaction des usagers des urgences.

Conclusion

Notre travail permet de confirmer la haute fréquence des VT dans les SAU, le lien entre les VT et des aspects organisationnels, l’importance d’un projet d’amélioration continue de la qualité fondé sur la qualité des soins comme outil pour atteindre une réduction des VT, et permet de proposer des indicateurs simples de suivi et de mesure de l’impact des stratégies mises en place.

Abstract

Introduction

Violence at work (VW) are very common in health care, especially in emergency department, and their reduction is considered as a priority. However, no study evaluating the efficacy of VW reduction policies are available. The aim of our work is to evaluate the strategy of VT reduction conducted in our emergency department (ED).

Method

A continuous quality improvement program was done in our ED in 2006. Their objectives were to improve quality of care and patients and healthcare workers security, to fight against patients and to develop centred patients care, and to reduce the number of VW. To measure the impact of the quality improvement project, we measured between 2006 and 2014: doctor waiting time, total time of length, number of VT, number of staff security interventions, healthcare workers absenteeism and user’s satisfaction.

Results

During the study period, we found a significant decrease (p <0.001) for the total length of stay, physician wait time, number of reported VW, number of security team interventions, and user’s satisfaction.

Conclusion

Our study confirms that VW is a frequent feature in ED, that a continuous quality improvement project is an efficient tool to achieve a reduction in VW, and that easy available parameter may be used as simple indicators to measure the impact of VW reduction policies in healthcare settings.

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Références

  1. Janoch JA, Smith TS (2008) Workplace safety and health in the health care and social assistance industry, 2003-2007. U.S. Bureau of Labor and Statistics. http://www.bls.gov/opub/mlr/cwc/workplace-safety-and-health-in-the-health-care-and-socialassistance-industry-2003-07.pdf

    Google Scholar 

  2. Kuehn BM (2010) Violence in health care settings on rise. JAMA 304:511–2

    Article  CAS  PubMed  Google Scholar 

  3. McPhaul KM, Lipscomb JA (2004) Workplace violence in health care: recognized but not regulated. Online J Issues Nurs 9:7

    PubMed  Google Scholar 

  4. European Agency for Safety and Health at Work (2010) ESENER European survey of enterprises on new and emerging risks. http://osha.europa.eu/en (dernier accès le 26/06/2015)

    Google Scholar 

  5. Kamchuchat C, Chongsuvivatwong V, Oncheunjit S, et al(2008) Workplace violence directed at nursing staff at a general hospital in Southern Thailand. J Occup Health 50:201–7

    Article  PubMed  Google Scholar 

  6. Gascón S, Martínez-Jarreta B, González-Andrade JF, et al(2009) Aggression towards health care workers in Spain: a multi-facility study to evaluate the distribution of growing violence among professionals, health facilities and departments. Int J Occup Environ Health 15:29–35

    Article  PubMed  Google Scholar 

  7. Hodgson MJ, Reed R, Craig T, et al(2004) Violence in healthcare facilities: lessons from the Veterans Health Administration. J Occup Environ Med 46:1158–65

    Article  PubMed  Google Scholar 

  8. Gerberich SG, Church TR, McGovern PM, et al(2004) An epidemiological study of the magnitude and consequences of work related violence: the Minnesota nurses’ study. Occup Environ Med 61:495–503

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Roche M, Diers D, Duffield C, Catling-Paul C (2010) Violence toward nurses, the work environment, and patient outcomes. J Nurs Scholarship 42:13–22

    Article  Google Scholar 

  10. Estryn-Behar M, van der Heijden B, Camerino D, et al(2008) Violence risk in nursing-results from the European “NEXT” study. Occup Med (Lond) 58:107–14

    Article  Google Scholar 

  11. Privitera M, Weisman R, Cerulli C, et al(2005) Violence toward mental health staff and safety in the work environment. Occup Med (Lond) 55:480–6

    Article  Google Scholar 

  12. Chen WC, Hwu HG, Kung SM, et al(2008) Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan. J Occup Health 50:288–93

    Article  PubMed  Google Scholar 

  13. Zampieron A, Galeazzo M, Turra S, Buja A (2010) Perceived aggression towards nurses: study in two Italian health institutions. J Clin Nurs 19:2329–41

    PubMed  Google Scholar 

  14. Franz S, Zeh A, Schablon A, et al(2010) Aggression and violence against health care workers in Germany- a cross sectional retrospective survey. BMC Health Services Research 10:51

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hahn S, Muller M, Needham I, et al(2010) Factors associated with patient and visitor violence experienced by nurses in general hospitals in Switzerland: a cross-sectional survey. J Clin Nurs 19:3535–46

    Article  PubMed  Google Scholar 

  16. Winstanley S, Whittington R (2004) Aggression towards health care staff in a UK general hospital: variation among professions and departments. J Clin Nurs 13:3–10

    Article  PubMed  Google Scholar 

  17. Lin YH, Liu HE (2005) The impact of workplace violence on nurses in South Taiwan. Int J Nurs Stud 42:773–8

    Article  PubMed  Google Scholar 

  18. Magnavita N, Heponiemi T (2012) Violence towards health care workers in a public health care facility in Italy: a repeated crosssectional study. BMC Health Serv Res 12:108

    Article  PubMed Central  PubMed  Google Scholar 

  19. Chen WC, Hwu HGH, Kung SM, et al(2008) Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan. J Occup Health 50:288–93

    Article  PubMed  Google Scholar 

  20. Gillespi G, Wilkerson William (2013) Experts: to crack down on violence in the ED, establish a robust system of reporting, educating staff. ED Manag 25:97–100

    Google Scholar 

  21. Estryn-Behar M, Duville N, Menini ML, et al(2007) Factors associated with violence against healthcare workers: results of the European Presst-Next study. Presse Med 36:21–35

    Article  PubMed  Google Scholar 

  22. Edward KL, Ousey K, Warelow P, Lui S (2014) Nursing and aggression in the workplace: a systematic review. Br J Nurs 23:653–4

    Article  PubMed  Google Scholar 

  23. Anderson L, FitzGerald M, Luck L (2010) An integrative literature review of interventions to reduce violence against emergency department nurses. J Clin Nurs 19:2520–30

    Article  PubMed  Google Scholar 

  24. Observatoire National de la violence dans les établissements de la Santé. Ministère des Affaires sociales, de la santé, et des droits des femmes (2014) Bilan 2012 de l’observatoire national des violences en milieu de santé (ONVS) http://www.sante.gouv.fr/bilan-2012-de-l-observatoire-national-des-violences-en-milieu-desante-onvs.html (dernier accès le 26/06/2015)

    Google Scholar 

  25. Duchateau FX, Bajolet-Laplante MF, Chollet C, et al(2002) Exposure of French emergency medical personnel to violence. Ann Fr Anesth Reanim 21:775–8

    Article  CAS  PubMed  Google Scholar 

  26. Alameddine M, Kazzi A, El-Jardali F, et al(2011) Occupational violence at Lebanese emergency departments: prevalence, characteristics and associated factors. J Occup Health 53:455–64

    Article  PubMed  Google Scholar 

  27. Behnam M, Tillotson RD, Davis SM, Hobbs GR (2011) Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 40:565–79

    Article  PubMed  Google Scholar 

  28. Gillespie GL, Gates DM, Kowalenko T, et al(2014) Implementation of a comprehensive intervention to reduce physical assaults and threats in the emergency department. J Emerg Nurs 40:586–91

    Article  PubMed  Google Scholar 

  29. Gacki-Smith J, Juarez AM, Boyett L, et al(2010) Violence against nurses working in US emergency departments. J Health Prot Manage 26:81–99

    Google Scholar 

  30. Magnavita N (2014) Workplace violence and occupational stress in healthcare workers: a chicken-and-egg situation-results of a 6-year follow-up study. J Nurs Scholarsh 46:366–76

    Article  PubMed  Google Scholar 

  31. Ogundipe KO, Etonyeaku AC, Adigun I, et al(2013) Violence in the emergency department: a multicentre survey of nurses’ perceptions in Nigeria. Emerg Med J 30:758–762

    Article  PubMed  Google Scholar 

  32. Taylor JL, Rew L (2010) A systematic review of the literature: workplace violence in the emergency department. J Clin Nurs 19:2520–30

    Article  Google Scholar 

  33. Kansagra SM, Rao SR, Sullivan AF, et al(2008) A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med 15:1268–74

    Article  PubMed Central  PubMed  Google Scholar 

  34. Gerdtz MF, Daniel C, Dearie V, et al(2013) The outcome of a rapid training program on nurses’ attitudes regarding the prevention of aggression in emergency departments: a multi-site evaluation. Int J Nurs Stud 50:1434–45

    Article  PubMed  Google Scholar 

  35. M Schmitt (2014) Bientraitance et qualité de vie, prévenir les maltraitances pour des soins et une relation d’aide humanistes, Elsevier Masson Ed. Paris 317 p

    Google Scholar 

  36. Casalino E (2014) Les urgences: du constat de la maltraitance à un projet qualité basé sur la bientraitance. In: M Schmitt, Bientraitance et qualité de vie, outils et retour d’expériences, Elsevier Masson Ed. Paris, p 213–23

    Google Scholar 

  37. Agence nationale d’accréditation et d’évaluation en santé (ANAES) (2003) Principes méthodologiques pour la gestion des risques en établissement de santé. http://nosobase.chu-lyon.fr/recommandations/anaes/2003_qualite_methodologie_ANAES.pdf (dernier accès le 26/06/2015)

    Google Scholar 

  38. HR Consulty Partners (2009) Qu’est-ce que la pyramide des accidents (Bird) ? http://www.capsecur.com/FAQ-livre-managersante-securite/Qu-est-ce-que-la-pyramide-des-accidents-Bird (dernier accès le 26/06/2015)

    Google Scholar 

  39. Ferns T (2006) Under-reporting of violent incidents against nursing staff. Nurs Stand 20:41–5

    Article  PubMed  Google Scholar 

  40. Kowalenko T, Gates D, Gillespie GL, et al(2013) Prospective study of violence against ED workers. Am J Emerg Med 31: 197–205

    Article  PubMed  Google Scholar 

  41. Gilchrist H, Jones SC, Barrie L (2011) Experiences of emergency department staff: Alcohol-related and other violence and aggression. Australas Emerg Nurs J 14:9–16

    Article  Google Scholar 

  42. Kennedy MP (2005) Violence in emergency departments: underreported, unconstrained, and unconscionable. Med J Aust 183: 362–5

    PubMed  Google Scholar 

  43. Gates D, Fitzwater E, Succop P (2003) Predicting assaults against caregivers in nursing homes. Issues Ment Health Nurs 24:775–93

    Article  PubMed  Google Scholar 

  44. Gillespie GL, Bresler S, Gates DM, Succop P (2013) Posttraumatic stress symptomatology among emergency department workers following workplace aggression. Workplace Health Saf 60:247–54

    Article  Google Scholar 

  45. Martini A, Fantini S, D’Ovidio MC, et al(2012) Risk assessment of aggression toward emergency health care workers. Occup Med (Lond) 62:223–5

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (AP-HP), service d’accueil des urgences (SAU), hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, F-75018, Paris, France

    E. Casalino, C. Choquet, S. Thomas & S. Erhel

  2. Université Paris Diderot, Sorbonne Paris Cité, EA 7334 « Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES) », Paris, France

    E. Casalino & C. Choquet

  3. Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France

    E. Casalino & C. Choquet

  4. Assistance Publique-Hôpitaux de Paris (AP-HP), sécurité antimalveillance, hôpital Bichat, Paris, France

    P. Cossard

Authors
  1. E. Casalino
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  2. C. Choquet
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  3. S. Thomas
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  4. S. Erhel
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  5. P. Cossard
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Groupe Projet Sécurité du service d’accueil des urgences Bichat

Corresponding author

Correspondence to E. Casalino.

Additional information

Berthelot JPh, Colosi L, Debit A, Fournau L, Guechi A, Hellman R, Hijazi M, Juillien G, Pigeau J, Moujaoui Ph, Kenway Ph, Clery R, Ranaivoson M

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Casalino, E., Choquet, C., Thomas, S. et al. La violence dans les services d’urgences : évaluation d’une politique de réduction de la violence dans un service d’accueil des urgences parisien. Ann. Fr. Med. Urgence 5, 226–237 (2015). https://doi.org/10.1007/s13341-015-0558-z

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  • DOI: https://doi.org/10.1007/s13341-015-0558-z

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