SHM Converge Scientific Abstract ePoster Gallery-Addressing Unsafe Inpatient Behavior and Workplace Violence: Administrative Discharge as a Last Resort

Pdf Summary

Oregon Health & Science University developed a comprehensive inpatient behavioral management policy to address unsafe or disruptive patient behavior and workplace violence. The project arose from the fact that healthcare workers experience high rates of violence, which can cause physical injury, psychological harm, burnout, absenteeism, and turnover.<br /><br />Although the hospital already had multiple tools in place—such as capacity assessments, behavioral codes, trauma-informed care, and expectations for respectful conduct—staff roles were sometimes unclear and unsafe behavior could continue. The team aimed to create a structured approach that would allow for administrative discharge from the hospital before medical readiness when a patient’s persistent behavior threatened staff or other patient safety.<br /><br />To build the policy, the group completed a cause-and-effect analysis to identify gaps in the existing response process and developed a driver diagram and multidisciplinary framework for triaging repeated disruptive behavior. The workflow included escalation to hospital administration for final decision-making when de-escalation efforts failed.<br /><br />The hospital reported success with this last-resort administrative discharge pathway. During calendar year 2023, five administrative discharges were completed. Most of these patients later returned to the facility and engaged better in their care, suggesting that the policy established boundaries without discouraging future treatment-seeking. Bedside staff also viewed the policy positively and reported feeling safer at work.<br /><br />Overall, the authors conclude that involving hospital administration in escalating unsafe behavioral situations is essential, and that administrative discharge can be an effective final option when all other attempts to resolve disruptive behavior have failed.

Asset Subtitle

Kellie Littlefield

Meta Tag

Author List Kellie Littlefield, Michael J. Hendricks

Category Innovations

Concept Workplace Violence

Concept Administrative Discharge

Concept Unsafe Behavior

Concept Disruptive Behavior

Concept Staff Safety

Distinguished Non-Finalist

Presenter Organization Oregon Health & Science University

Presenting Author Kellie Littlefield

Track Value in Hospital Medicine

Keywords

behavioral management

workplace violence

inpatient policy

administrative discharge

patient safety

healthcare worker safety

disruptive behavior

de-escalation

hospital administration

Oregon Health & Science University

Workplace Violence

Administrative Discharge

Unsafe Behavior

Disruptive Behavior

Staff Safety