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Duress Buttons Keep Panic at Bay

HOSPITALS ARE MEANT to stand as sanctuaries where healing can occur in a peaceful environment. Unfortunately, that is often not the case. “Violence in healthcare is very real. It’s all numbers on paper, but if you’re a nurse or security officer dealing with it, it becomes a serious concern,” says Eric Smith, CPP, security director for Exempla Healthcare at Exempla Saint Joseph Hospital in Denver.

Smith oversees security in three hospitals, the Sisters of Charity corporate office, and a boarding school for troubled youth. The flagship facility, Saint Joseph, is in the heart of Denver on a 14-acre campus. It includes 565 beds, 30 operating theaters, and a large emergency room (ER). Saint Joseph sees an excess of 18,500 patient admissions annually, as well as more than 169,000 outpatient visits, nearly 52,000 ER visits, and close to 4,000 births. Staff includes approximately 4,850 employees and physicians and 400 volunteers.

On the extreme end, “We’ve had a number of incidents—some pretty serious assaults. We’ve had [patients] commit suicide, and we’re in a high-crime area,” he states. “It’s almost a steady thing, too—some kind of violent act where security… or nurses are getting assaulted. And fortunately, it’s not usually a very serious thing, but still, no one wants to go to work and worry about getting a black eye.”

Staff had approached security in the past, inquiring about a panic-button system to speedily notify security of an incident taking place. “The big challenge was to get the capital to do it,” explains Smith. “A lot of systems require hardwiring the buttons to a desk in a central location—that ends up with the need for cables run to a network closet tied to a phone line that runs to a dispatch center.”

In the case of Saint Joseph, such a system would necessitate “running cables through patient care areas and entail putting up containment to keep the installation from affecting the patients, and it becomes a challenge and costly to do,” he says.

But the requests for duress buttons continued “on a regular basis,” and, in late 2012, Smith says he heard of a potentially suitable system through one of his contacts in the International Association for Healthcare Security and Safety (IAHSS). The then-president of the IAHSS’s Colorado Chapter was Eric Banghart, senior business development manager for Inovonics Wireless Corporation of Louisville, Colorado, a provider of enterprise life-safety and specialized commercial wireless systems.

Banghart told Smith about the Radius Enterprise Mobile Duress (EMD) system, which offers a type of button that is not tied to a particular spot, but can be carried by staffers. It is a wireless system that functions by the use of repeaters. “I liked this system because it runs on a wavelength that [would not] interfere with anything else in the hospital,” Smith explains.

The Radius EMD system also promised near-instant communication. Other duress systems that Smith had investigated “had a two-minute lag until security received the message…. A nurse left to deal with a combative patient for two minutes—blaming the duress button is not going to fly. It’s still going to be seen as security’s fault.”

Inovonics’ Banghart explains the philosophy behind the Radius EMD system. “Panic buttons need to be mobile. They also must be able to locate where the user is in the facility with some level of accuracy. The system should reside on an appropriate network that is security hardened and designed around security, mission-critical, and life-safety applications. They should cover a large number of users in a scalable fashion—one department, or several, or an entire building or campus.”

Radius EMD’s wireless repeaters “create a mesh network wherever you want,” says Banghart. “The repeaters require local power, but have batteries that last up to 24 hours if there is an outage. A network coordinator connects the server at the front end, so it manages the mesh network, capturing button activation signals.” The signals are fed by the network coordinator to a server, “where the brains of the system reside. This is not a system where you watch a screen and monitor what’s going on; it’s about mobile buttons being activated, the network picking this up, the signal being located, and then sending that alert message directly to a mobile responder in a variety of formats—over two-way radio to a security responder, or over phone lines, cell phones, pagers, e-mail, or public address systems. Or the signals could go to a dispatch center, as it does at Saint Joseph.”

Smith did not have enough funds to cover the entire hospital at one time, so he selected the top three problem areas. The behavioral health unit “had a high level of combative patient incidents, and the director of the ICU was concerned about security because of some of the family dynamics in the waiting area.” The ER, with its difficult patients and possibilities of spillover and domestic violence, was also selected. “The only other department I would have liked to include was labor and delivery because we get a lot of—frankly—Jerry Springer-type stuff that goes on,” he states.

The scalable system allows an unlimited number of duress buttons, but Smith decided to limit the number to 45. “On-duty personnel get them when they start their shift; they wear them throughout their shifts, and then they turn them over to their relief,” he says. Smith selected a two-button model that signals after both buttons are pressed for one second. Staff from the three units were given samples of the types of buttons available before Smith made the purchase. The staff decided that a belt-clip version was easiest to use.

The installation began last July, was completed by August, and staff had the buttons by early September. Twelve repeaters were installed to cover the chosen units. The repeaters catch and send the duress signal to the security dispatch center, which then sends a group notification to all security officers on duty. During incidents, “it takes about 20 seconds from the time the button is pushed to security hearing the call…. I am very pleased with that,” Smith says, adding that the installation was trouble-free.

When the buttons were given to the staff, security conducted training. Afterwards, Smith recalls, “There were a few questions during the first week and a few nurses who felt they hadn’t had the right training…. I think they weren’t convinced that all they had to do to get help was hit the button. So, we repeated training a couple of times.” One of the features that security pointed out to staff was an LED on the button that illuminates to show that the duress signal has been received by security.

At the time of this interview, Saint Joseph staff had been using the Radius EMD system for about two and-a-half months. “It’s a very flexible system and the feedback from the nurses has been tremendous,” says Smith.

A button is also carried by the security officer posted in the ER. “We’ve had problems with our radios there. That’s one of our dead spots and also where we have high-risk patients,” according to Smith. Shortly after the system went into use, a suicidal patient tried to strangle himself while in the ER. The security officer “couldn’t get help on the radio, so she used the button and immediately security dispatch got the message and help was there within about 30 seconds,” he states.

Smith says that Exempla is building a new Saint Joseph hospital that will be open by the end of 2014. “I would like to get the EMD system in the new hospital in the high-risk units, and also add it to labor and delivery and a few other units. It’s a lot easier to get in there during the building phase,” he notes.