Abstract Introduction The use of uniformed security in inpatient settings is common and may mark events perceived as physically and/or psychologically threatening in clinical spaces. Despite the importance to workplace safety and patient- and family-centered care initiatives, there is no existing evidence nor established standards of care guiding security officers’ clinical roles. Therefore, we aimed to (1) characterize events precipitating security activation, (2) quantify resultant outcomes, and (3) identify contextual factors associated with security engagement. Methods We conducted a retrospective, mixed-methods descriptive case review of all security log activations for three medical ICUs at a single urban institution from July 2023 to July 2024. Three investigators independently reviewed data from the security logs and clinical chart data, including narrative documentation, for each logged security activity. We captured and classified patient demographics and clinical information, reason for security activation, and any resulting interventions. We wrote a case summary for each event, triangulating all available data. Five investigators developed an emergent coding framework and applied this to all summaries. We performed descriptive analyses of code frequencies and patient demographic characteristics to identify patterns. Our methods were not designed to capture events handled without security involvement. Results We identified 69 security incidents involving 58 patients. Seven events could not be linked to a patient’s electronic health record. Of linked cases, patients were 48.3% women, 50.0% Medicaid-insured, 44.8% Black, and 34.5% White. Patients’ mean age was 48.7 years. Most incidents (58.0%) occurred during daytime shift (0700-1900). Common contextual factors included patients at high risk of death (47.8%), substance use (40.6%), and behavioral health diagnoses (29.0%). Reasons for security involvement included patient confusion or agitation (36.2%), patient-directed discharge attempt (34.8%), hospital policy violations (33.3%), patient or family disagreement over clinical care (30.4%), and perceived verbal threats to staff (30.4%). A minority of events were due to perceived physical threats to staff (13.0%), threat of visitor to patient (8.7%), or intra-family conflict (5.8%). Physical or chemical restraints were used to respond to 20.6% of events. We summarize findings in a proposed conceptual model (Figure). Conclusions Security activations were frequent in the medical ICU setting. Social, structural, and clinical factors may have shaped whether staff perceived an event as a threat necessitating security support. Trauma-informed, multidisciplinary models that identify and incorporate patient, family, and staff needs during high-stakes clinical care may reduce the frequency of perceived threats and improve responses to such threats. This abstract is funded by: University of Pennsylvania
Hart et al. (Fri,) studied this question.