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Ambulatory Buzz

Information on all things ambulatory from The Joint Commission

De-Escalating Violence in Ambulatory Care Settings


Young blonde surgeon doctor woman over isolated background afraid and terrified with fear expression stop gesture with hands, shouting in shock. Panic concept.

By Elizabeth Even, MSN, RN, associate director, Standards Interpretation

There’s been a growing awareness of workplace violence potential in hospitals, but ambulatory providers are not immune.

In fact, according to an executive brief issued by ECRI Patient Safety Organization (PSO) in 2019, workplace violence is one of the top four key risks in ambulatory care.

By now, we are all familiar with the statistic that health care workers are more at risk of encountering workplace violence than staff in other industries. 

Most of my health care experience has been in hospital settings and there’s a certain comfort level that goes with knowing security is available with a quick phone call or push of a panic button (even though their presence doesn’t always guarantee to de-escalate an incident). According to the brief, many staff in ambulatory care organizations face increased exposure to dangerous confrontations because of easy individual movements throughout the premises.

De-Escalating Violence
On a positive note, understanding the root of the behaviors can mitigate dangerous events 85% of the time. Anyone working in an organization can de-escalate an agitated patient or family member. It doesn’t have to be a physician or nurse but a staff member who has good communication skills and can show compassion can defuse a potentially dangerous situation. The important thing is getting this type of education and training out to all staff as this will ensure everyone is less caught off guard and more prepared to react at a moment’s notice which can make all the difference to the safety of your patients as well as your staff.

Some tools that I think are especially helpful include:

While much of the focus this year has been on the COVID-19 pandemic, the risk of violence in our workplace isn’t going away. What resources is your ambulatory care organization using for violence prevention or de-escalation?

Elizabeth Even, MSN, RN, CEN, is associate director, Clinical Standards Interpretation Group, for The Joint Commission. She is also on staff in the emergency department at Northwestern Memorial Hospital. Prior to this position she managed the emergency department at Northwestern Memorial Hospital and was a clinical educator at Northwestern University Feinberg School of Medicine.  She also has experience in home health and working as a nurse at Wrigley Field in Chicago.