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How one emergency department director works to reduce risks of violence

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How one emergency department director works to reduce risks of violence

Picture of Laura Tsutsui
Saint Agnes' Emergency Services Director, Joyce Eden, has an office that she calls her "wild kingdom." However, she carves out t
Saint Agnes' Emergency Services Director, Joyce Eden, has an office that she calls her "wild kingdom." However, she carves out time every day to walk around the department, and hear employee and patient feedback.
(Photo: Laura Tsutsui/Valley Public Radio)
Valley Public Radio
Wednesday, October 31, 2018

In our series, Part of the Job, we’ve looked at how California’s health institutions are trying to reduce the rate of violence and harassment against those who work in health care. Working in one of the highest risk areas of a hospital only adds to the challenge.

Saint Agnes Medical Center in Fresno’s emergency department of sees anyone who comes through their doors, and that includes patients “shopping” for opioid prescriptions.

“They’ll say, but these are prescriptions, these were given to me,” says Joyce Eden, Saint Agnes’s emergency services director.

“Yes they were, but now how you’re using them isn’t to treat pain, you’re actually now using them for the high and the other feelings you get.”

She says that sometimes, things escalate.

“We actually have had to call Fresno police department periodically, we have to notify security because when we let them know we’re not able to refill their narcotics or other opioid prescriptions that they have, we do get threatened and we have to take all threats seriously.”

Dealing with threats is one part of the job. But she does more than that.

“I’m watching for patients or visitors who might be acting in a way that is of concern and I will get someone to screen that, or I'll screen it,” Eden says. “Nurses and physicians will tell you that all the time: You might look perfectly fine, but something inside me is telling me, no it’s not, and then we keep digging until we get to that answer.”

Matt Thomas, Saint Agnes’ environmental safety officer, says all of the hospital’s employees get violence prevention and awareness training, but those who work in the emergency department get more.

“They see the most instances of violence within their positions. They are required to take what we call CPI training, crisis prevention training,” Thomas says. “That's verbal de-escalation techniques, awareness, and it's in a classroom setting where we work with a CPI instructor from the hospital.”

The rate of incidents has increased over the years. Eden says there are a few reasons for this. Mental health services have shrunk. This means people seeking psychiatric treatment sometimes come to the emergency department. It’s the same for people who don’t have insurance or primary care. And more people coming through the department means a higher risk of incidents. In response, the hospital has been testing ways to make the department more efficient.

“So one of the things that they studied was the times of day when that waiting room gets really busy and, and about how many people could the waiting room tolerate,” Eden explains. “So we initially used to only have one triage desk. If we get past a certain wait time in the lobby, then we’ll activate a second triage team, because if we can get those triages done and figure out what level of care they need, then we can keep that volume in the lobby down and the wait time to figure that out.”

Eden says her background has uniquely prepared her for a job like this.

“I was born in West Africa, and in fact one of the really fun things about my career and my life is I think it's important to know how to do things with very little because then you honor when you have a lot,” Eden says. “Sometimes you don't have a lot and you can learn how to still safely do things even when you don’t have all the latest technology and best supplies.”

Eden says, it’s this resourcefulness, along with help from her colleagues, that makes it possible to work in the place that’s ready and waiting, literally, for the next emergency.

[This story was originally published by Valley Public Radio.]