title: Prevalence of Horizontal Violence Among Emergency Attending Physicians, Residents, and Physician Assistants.
abstract: BACKGROUND
  Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs).
  
  
  METHODS
  We sent an electronic survey to emergency medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in three unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily) they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care.
  
  
  RESULTS
  Of the 122 survey invitations 91 were completed, yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault) to 34.1% (Q4: been shouted at). Fourteen of these behaviors were most prevalent in the attending cohort, six were most prevalent in the MLP cohort, and three of the behaviors were most prevalent in the resident cohort.
  
  
  CONCLUSIONS
  The HV behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2%) indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients.
authors.affiliation: Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Auburn Hills, Michigan.
authors.forename: Nico B
authors.initials: NB
authors.lastname: Volz
authors.affiliation: Beaumont Health, Department of Emergency Medicine, Royal Oak, Michigan.
authors.forename: Ryan
authors.initials: R
authors.lastname: Fringer
authors.affiliation: Beaumont Health, Department of Emergency Medicine, Royal Oak, Michigan.
authors.forename: Bradford
authors.initials: B
authors.lastname: Walters
authors.affiliation: Beaumont Health, Department of Emergency Medicine, Royal Oak, Michigan.
authors.forename: Terry
authors.initials: T
authors.lastname: Kowalenko
mesh_terms: D000328:Adult; D017677:Age Distribution; D000378:Agonistic Behavior; D001291:Attitude of Health Personnel; D058445:Bullying / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D016273:Occupational Exposure; D010823:Physician Assistants / Q000523:psychology* / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D010865:Pilot Projects; D015995:Prevalence; D011787:Quality of Health Care / Q000592:standards*; D017678:Sex Distribution; D012919:Social Behavior; D055815:Young Adult