title: Incidence and impact of physician and nurse disruptive behaviors in the emergency department.
abstract: BACKGROUND
  Disruptive behaviors have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events.
  
  
  OBJECTIVE
  To assess the status of disruptive behaviors and staff relationships in the ED setting.
  
  
  METHODS
  A 23-question survey tool was distributed to a regional group of ED physicians, nurses, and staff members to assess their perceptions as to the incidence of discipline-specific occurrences, types and impact of disruptive behaviors on staff behaviors, communication efficiency, and patient outcomes of care.
  
  
  RESULTS
  A total of 370 surveys were received. Fifty-seven percent witnessed the disruptive behaviors by physicians, 52% witnessed the disruptive behaviors by nurses; 32.8% of the respondents felt that disruptive behavior could be linked to the occurrence of adverse events, 35.4% to medical errors, 24.7% to compromises in patient safety, 35.8% to poor quality, and 12.3% to patient mortality. Eighteen percent reported that they were aware of a specific adverse event that occurred as a direct result of disruptive behavior.
  
  
  CONCLUSIONS
  Disruptive behaviors in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognize the significance of disruptive behaviors and implement appropriate policies and protocols to address this issue.
authors.affiliation: Physician Wellness Services, San Francisco, California, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Rosenstein
authors.forename: Bruce
authors.initials: B
authors.lastname: Naylor
mesh_terms: D000288:Administrative Personnel / Q000523:psychology / Q000706:statistics & numerical data; D000367:Age Factors; D000378:Agonistic Behavior; D000488:Allied Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003469:Culture; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008297:Male; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D005791:Patient Care; D017060:Patient Satisfaction; D010551:Personality; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012737:Sex Factors; D012919:Social Behavior; D011795:Surveys and Questionnaires