Hospital security is being assessed with greater concern and in more detail than ever before.

This heightened focus comes as hospitals have experienced several violent incidents and threats in recent years.

High-profile cases last year included the shooting of a physician at Johns Hopkins Hospital by a patient's son, who then killed his mother and himself, and the strangulation murder of a psych tech by a patient-inmate at Napa State Hospital in California.

Over the past year, 23 percent of hospitals reported an overall increase in attacks and assaults, compared with 10 percent reporting a decrease; 34 percent reported a rise in patient and family violence against emergency department staff and 29 percent reported an uptick in patient and family violence against other staff.

These are some of the key findings from the 2011 Hospital Security Survey by H&HN's sister publication Health Facilities Management and the American Society for Healthcare Engineering. The survey was sponsored by Boca Raton, Fla.-based ADT Security Services Inc.'s Healthcare Solutions group.

Despite the tough financial challenges facing hospitals, nearly half the respondents said their security department's budget increased in 2011, while more than a third said there was no change. Almost 70 percent said their hospital's security strategic plan had been updated within the past 12 months. In addition, a large majority said their facilities had adopted workplace-violence and active-shooter policies to prepare staff for handling emergencies.

The Bureau of Labor Statistics reports that from 2003 to 2007, nearly 60 percent of all nonfatal as­saults and violent acts in U.S. workplace settings occurred in the health care and social assistance industry. Additionally, while homicides and shootings in health care settings are rare, there were 73 murders in health care settings, including 20 in hospitals from 1997 through 2009.

Nursing staff in emergency departments, intensive care units and psychiatric units are
particularly at high risk of being victims of violence. More than 1 in 10 ED nurses surveyed last year said they had been attacked in the previous week, according to the Emergency Nurses Association. Many observers attribute the increase in violence in some hospitals to heightened stress faced by patients, family members and staff as increasing numbers of unemployed, uninsured, drug-using and mentally ill people seek care they can't access elsewhere.

"There's a mental health crisis in this country," says Tom Smith, director of hospital police and transportation at University of North Carolina Hospitals. "There are far fewer community resources for mental health care, so these patients are showing up in the ED much sicker and more prone to violence, and they stay longer once they get here. We're all trying to find ways to manage them in a safe, humane way."

Because of the increased attention to violence, the Joint Commission, hospital industry groups, federal and state regulators, and hospital employee unions have pressed for better security programs and more complete reporting of incidents.

One of the most controversial security issues is whether to have hospital security officers carry electronic control devices such as Tasers. The HFM/ASHE survey found that only 12 percent of survey respondents said their officers carry such devices, 9 percent said their hospitals are testing them, and 79 percent said they have no plans to use them.

Hospitals aren't moving to adopt metal detector systems either. The survey found that only 13 percent of respondents said their hospitals had implemented them, while 7 percent are planning to do so in the next 24 months. Eighty percent had no plans to adopt them.