How to Keep Patient Watches from Eroding Your Hospital Public Safety Department

Assistants could help ease the workload of security officers monitoring behavioral health, violent or intoxicated patients.

Let’s face it: the need for patient watches for behavioral health patients, intoxicated patients and violent patients is not going away anytime soon. In fact, with the dwindling amount of resources available to patients with mental health needs, we can expect that the resources required to manage these patients safely in our emergency departments (EDs) will only increase.

However, many hospital security departments have now found themselves holding the bag when it comes to meeting the demand for these watches. Not only that, but these same departments now struggle with maintaining the right level of security for the rest of the hospital while their staff is tied up in the ED. But, there is a solution out there that is gaining momentum in some hospitals- the Patient Safety Assistant (PSA) model.

The Scope of the Problem
I’m here to tell you that you are not alone when it comes to this problem. In fact, many of my colleagues across the country are struggling with this problem right now.

It starts out innocently enough—maybe your officers started watching patients occasionally as a way to help out the ED staff, but then it slowly grew to pulling more and more of your department’s resources away from other essential tasks. I know of many security directors and managers whose officers are dedicating hundreds to thousands of hours in the ED watching patients every month. These are hours that were previously dedicated to proactively patrolling the hospital, answering calls for service, assisting people with directions, staffing access control points and more. Some directors and managers are even doing patient watches themselves!

RELATED: How to Reduce Emergency Department Violence

This is where things start to get dangerous. How can you keep your hospital community safe when some or all of your department is tied up on patient watches? How can you run your security program from the bedside of a suicidal patient?

Unfortunately, like many things we deal with in healthcare security, there is no easy answer to this complex issue. However, none of this is going to be resolved without a collaborative approach involving the security department, the ED and executive leadership. That’s right. You can’t fix this situation on your own, and you will eventually run out of bodies to throw at the problem. It’s only going to get worse if you choose to keep following the same path.

The Rise of the Patient Safety Assistant
So, now you’re probably asking what you CAN do about the EDs unquenchable thirst for your officers’ time. Well, one of the best approaches that I have seen out there is the use of specially trained and selected Patient Safety Assistants (PSAs) to watch patients.

These are not employees of the security department typically but are part of the clinical staff. They usually have a background in mental health gained through hands-on clinical experience, an advanced education in psychology, or both. Also, they have the willingness and physical ability to handle themselves and the patient when things get out of control. No, I’m not talking about hiring an army of 6’5″, 350 lb. psychology majors from your nearby university.

The ideal candidate is better with their de-escalation skills than their ability to single-handedly restrain an aggressive patient. What also counts is that they know what they’re getting into and won’t shy away from stepping in to mitigate a violent situation when verbal de-escalation fails. Ultimately, most patient watches are uneventful and involve many tedious hours of observing a patient who is asleep, medicated or who may need frequent redirection. So, a third important quality is that these PSAs need to be okay with a certain amount of tedium in their job.

Is this the secret to your officers never watching another patient again?  Not necessarily. There are going to be times when an extremely violent patient needs a security officer to watch them until medication kicks in or until they are otherwise deescalated. There may be other exceptions as well. However, these exceptions should be few and far between. Also, keep in mind that you should have a consistent presence in your ED so that officers can respond in seconds to escalating issues. This will also serve to keep the PSAs and other clinical staff feeling safe in the absence of security officers as patient observers.

Where to Start: Building Momentum for PSAs
Now, you are probably saying to yourself, “This all sounds like a good idea, but how do I get something like this rolling at my hospital?” I’m not going to sit here and tell you that it’s easy, because it’s not. My suggestion is to look at your current situation and gather data on what you are doing. Here are some questions to ask about your current state of affairs:

  • How many hours is your staff putting into patient watches?
  • What did officers do before they were tasked with watches (patrols, calls for service, access control, etc.)?
  • What are the impacts to the security program and the hospital community as a whole because of these reallocated hours?
  • What level of risk is the hospital now assuming because of this change in security posture (e.g. what could happen when your campus grounds and parking lots aren’t patrolled for two consecutive shifts after dark)?

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