How Colorado ASC staff de-escalated a hostile situation: 7 insights

When a patient at an ASC on Aurora-based University of Colorado Anschutz Medical Campus became verbally abusing and threatening, staff worked quickly to de-escalate the situation, Anesthesia Experts reports.

Seven takeaways:

1. Researchers explained the situation at the 2018 Society for Ambulatory Anesthesia meeting, May 3-5. They said the incident underscored the need for ASCs to adopt protocols for managing aggressive patients, as they don't have large security departments like hospitals.

2. In the Colorado incident, when the patient arrived at the ASC for a colonoscopy, she made several demands regarding her IV tube placement. An anesthesiologist struggled to place the IV in the location the patient specified, and the patient began swearing.

3. After the anesthesiologist and certified registered nurse anesthetist present discussed how to proceed without causing the patient pain, the situation escalated. The patient called the CRNA a "whore" and threatened the CRNA, anesthesiologist, gastroenterologist and nurse in the room. The patient also told a member of the anesthesia team, "I'm going to kill you."

4. The patient remained verbally aggressive throughout her two-hour visit, but the colonoscopy was performed successfully.

5. The incident led study author Ramakrishna Gumidyala, MD, and his colleagues to develop a policy for addressing and defusing similar incidents. Their proactive approach involves encouraging communication among staff members and making everyone aware of safety protocols. Signs describing disruptive behavior are displayed throughout the surgery center.

Dr. Gumidyala said, "The earlier you can flag potential concerns and make everyone on staff aware, the more likely you are to contain a situation that doesn't need to escalate."

6. Dallas-based United Surgical Partners International Senior Vice President of Clinical Operations Ann Shimek, RN, said USPI has similar policies in place at its facilities.

"Situations like this are rare, but they do happen," Ms. Shimek said. "It's important to have everyone on staff be aware when there's a potential incident, and to know the protocol for what to do in a dangerous situation. Usually, we try to get the physician involved, and the medical director if they're present, to de-escalate the situation."

7. The Joint Commission published an advisory on de-escalation techniques Jan. 28, noting 25 percent of nurses reported being assaulted by patients or a patient's' family members. The alert also stated the CDC has observed a rise in workplace violence.

Click here to read The Joint Commission's safety alert regarding de-escalation models.

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