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January 5, 2015

Hospital Violence Reduction – Sentinel Events

Violence in the Hospital as a Sentinel Event/Near Miss

The Joint Commission has identified that violence and aggression in healthcare settings has significant potential to undermine the operations of healthcare facilities.

Once considered safe havens, health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide. As criminal activity spills over from the streets onto the campuses and through the doors, providing for the safety and security of all patients, visitors and staff within the walls of a health care institution, as well as on the grounds, requires increasing vigilant attention and action by safety and security personnel as well as all health care staff and providers.

Sentinel Event Alert 45, The Joint Commission

The violence category of sentinel events is consistently among the top 10 types of sentinel events reported to The Joint Commission. Since 2004, the Sentinel Event Database has indicated significant increases in reports of violence.

Of the information in the Joint Commission Sentinel Event Database regarding violence, the following contributing causal factors were identified most frequently:

Leadership, noted in 62 percent of the events, most notably problems in the areas of policy and procedure development and implementation.

Human resources-related factors, noted in 60 percent of the events, such as the increased need for staff education and competency assessment processes.

Assessment, noted in 58 percent of the events, particularly in the areas of flawed patient observation protocols, inadequate assessment tools, and lack of psychiatric assessment.

Communication failures, noted in 53 percent of the events, both among staff and with patients and family.

Physical environment, noted in 36 percent of the events, in terms of deficiencies in general safety of the environment and security procedures and practices.

Problems in care planning, information management and patient education were other causal factors identified less frequently.

Definition of a Sentinel Event:

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function.  The phrase, “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Such events are called “sentinel” because they signal the need for immediate investigation and response.

It is our opinion that some of the incidents of serious violence exhibited towards staff or others within Hospital Trauma Centres or Psychiatric Services should be considered, at least for internal reporting and management purposes, as Sentinel Events and/or Near Misses.


Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant.  He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict.  www.dynamis.training

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Gerard O'Dea

Gerard O'Dea is the Director of Training for Dynamis. Training Advisor, Speaker, Author and Expert Witness on Personal Safety, Conflict Management and Physical Interventions, he is the European Advisor for Vistelar Conflict Management, a global programme focussing on the spectrum of human conflict.

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