A study by Connecticut Children’s utilizing Artificial Intelligence identified 26 episodes of violence against healthcare workers at two participating Massachusetts pediatric hospitals in 2022 — Boston Children’s Hospital and South Shore Hospital. But only seven incidents were reported in nurses’ informal notes.
The AI tool was programmed to analyze nurses’ hand off notes to identify violence towards them perpetrated by teen patients. The tool combed 19,000 informal notes between July-December 2022 from which it identified cases of physical assault, verbal assault, and outbursts that required patients to be either physically or medically restrained.
“What surprised me the most was that there was such underreporting of violence against staff,” said Mark Waltzman, a lead researcher of the study published in the August issue of the journal Pediatrics.
“There are systems in place for staff to report, however whether staff feel the events did not meet the level for the reporting standards or the systems are not convenient to use, remains to be determined,” said Waltzman, chief of pediatrics at South Shore Hospital, assistant professor of pediatrics at Harvard Medical School, and senior associate in emergency medicine at Boston Children’s Hospital.
Nationally, 1 in 4 nurses in the U.S. are assaulted by patients but only 20-60% of incidents are reported, according to the American Nurses Association.
“This nurse is going home frustrated after putting their heart and soul into work, and then somebody assaulted them, and then they decided not to report this,” said Dr. Amir Kimia of Connecticut Children’s, a medical informatics practitioner and a lead researcher of the study. “Having a system where somebody can then reach out and call and say, you know, hey, are you doing okay?”
The AI also started to flag cases where a patient was having a violent episode against a visiting family member, or was banging their head against the wall. The researchers then began adding these events to their surveillance.
The software identified six self-harm cases and four cases where patients assaulted their own family members.
Kemia said now that the researchers have proof of concept, the next phase is prospective surveillance.
“So that means we want to have a human vet these results on a regular basis [and] we're working to see what the exact timeframe should be – every two or three days, or one or two a week,” he said. “We want to capture the near-real time, and we're going to now disseminate it across a couple of institutions that are willing to participate and run the surveillance system.”
One concern is whether surveillance could change the way nurses document hand off notes.
“Are they going to be worried about some big brother looking at their notes?” said Kemia. “We are doing a little investigation into this to make sure that people don't feel that way before we go ahead and do the prospective surveillance.”
Al Ozonoff, Precision Vaccines Program at Boston Children's Hospital and associate professor of pediatrics at Harvard Medical School, was hopeful that the findings will result in a closer look by leadership in health care organizations that violence toward nurses remains a critical issue.
“We plan to use these findings to improve our ability to identify more events,” he said. “The first step towards understanding and addressing a problem is to gather information and data.”
