Workplace violence (WPV) has been extensively studied in hospitals, yet little is known about WPV in outpatient physician clinics. These settings and work tasks may present different risk factors for WPV compared to hospitals, including the handling/exchange of cash, and being remotely located without security presence. We conducted a systematic literature review to describe what is currently known about WPV in outpatient physician clinics. Six literature databases were searched and reference lists from included articles published from 2000–2019. Thirteen quantitative and five qualitative manuscripts were included which all focused on patient/family-perpetrated violence in outpatient physician clinics. No studies examined other violence types (e.g., worker-on-worker; burglary). The overall prevalence of Type II violence ranged from 9.5% to 74.6%, with the most common form being verbal abuse (42.1–94.3%), followed by threat of assault (14.0–57.4%), bullying (2.5–5.7%), physical assault, (0.5–15.9%) and sexual harassment/assault (0.2–9.3%). Worker consequences included reduced work performance, anger, and depression. Most workers did not receive training on how to manage a violent patient. More work is needed to examine the prevalence and risk factors of WPV in outpatient physician clinics for purposes of informing prevention efforts in these settings.

Experience gained from involvement in a number of emergency response activities since September 2001 in Texas indicated that the likely roles of statewide medical reserve corps units typically included aspects such as crowd control, registration and tracking, and information management. The need for training specifically focused on these likely roles became apparent. A novel field training exercise was developed that specifically focused on these likely roles. The exercise centered on a scenario involving the surreptitious placement of radioactivity in high traffic areas across the country, resulting in the contamination of large numbers of individuals. Because the source of the contamination was unknown, surge capacity contamination screening and data collection centers became necessary. Feedback collected from drill participants was measured to be overwhelmingly positive, with the vast majority of participants indicating a marked improvement in their understanding of their likely roles in a disaster of this type. The approach used in this training effort may be of use to other disaster surge capacity organizations as part of their strategic planning efforts as a means of ensuring that individuals involved in response activities possess familiarity with their likely roles during a wide scale public health disaster event.

Occupational radiation protection programs rarely encounter readily observable workplace injuries or illnesses, so upper management must rely on different indicators of relative performance. In many cases, the number of violations, complaints, and reported incidents is used. As with reported workplace injury and illness data, violation, complaint, and incident data provide only a crude indication of a radiation protection program's overall effectiveness. Even so, it is important to recognize that tangible program outcome measures such as these often dictate management decisions. Hence, safety professionals should have access to baseline violation, complaint, and incident trend data so that more informed preventive strategies can be put into place where possible. To assess the outcomes of radiation protection programs in Texas, data from regulatory compliance activities for a 10-y period, inclusive of calendar years 1988 to 1997, were assembled, summarized, and independently verified. For licensees of radioactive material, the ten most frequently cited violations represented 64% of the total issued during the study period. For registrants of radiation producing devices, the ten most frequently cited violations accounted for 73% of the total. A particular emphasis on proper recordkeeping is evident, and should be noted by any internal radiation protection quality assurance programs. Regardless of the permit type, the vast majority of violations issued were classified as low severity. Licensees were found to be involved in approximately 73% of the incidents recorded, with overexposures and badge overexposures representing the largest identifiable types. Registrants were found to be involved in approximately 57% of the complaints recorded, with the largest identifiable issue being concerns about health care provider qualifications or performance. Although this study was limited to a single state, the results can be of benefit to both quality assurance programs and professional health physics training courses by objectively identifying the areas commonly found to be deficient.

Experience gained during a field training exercise with a Medical Reserve Corps unit on the screening of large groups of individuals for possible contamination with radioactive material revealed that while exercise participants were generally attentive to the proper use of protective equipment and detectors, they tended to overlook important basic risk communications aspects. For example, drill participants did not actively communicate with the persons waiting in line for screening, a step which would provide re-assurance, possibly minimize apprehension, and would clarify expectations. When questioned on this issue of risk communication, drill participants were often able to craft ad hoc messages, but the messages were inconsistent and likely would not have significantly helped diminish anxiety and maintain crowd control. Similar difficulties were encountered regarding messaging for persons determined to be contaminated, those departing the screening center, and those to be delivered to the media. Based on these experiences, the need for a suggested list of risk communication points was identified. To address this need, a set of risk communication templates were developed that focused on the issues likely to be encountered in a mass screening event. The points include issues such as the importance of remaining calm, steps for minimizing possible intake or uptake, considerations for those exhibiting acute injuries, expected screening wait times, the process to be followed and the information to be collected, the process to be undertaken for those exhibiting contamination, and symptoms to watch for after departure. Drill participants indicated in follow-up discussions that such pre-established risk communication templates would serve to enhance their ability to assist in times of emergency and noted the potential broader applicably of the approach for use in responses for other disasters types as well.

In 1992, the University of Texas Health Science Center at Houston Radiation Safety Program began assembling data on a monthly basis that described various program activities. At the end of calendar year 2002, a decade of data had been collected, so the information was summarized into a novel program prospectus, displaying various indicator parameters in a format similar to that used in a commercial enterprise prospectus provided to potential investors. The consistent formatting of the data afforded a succinct and easily digestible snapshot of program activities and trends. Feedback from various program stakeholders, even those unschooled in radiation safety matters, was overwhelmingly positive. The prospectus aided in communicating the scope of work undertaken by the program, and has helped maintain program support, even in challenging economic times. The data summary is also proving to be useful in making future projections regarding program needs.

As part of its annual broad scope license radiation protection program review, the University of Texas Health Science Center at Houston radiation safety program discovered that although inventory control and monitoring mechanisms were being effectively implemented at the sublicensee level, a method did not exist to demonstrate compliance with collective broad scope license possession limits at the institutional level. To address this shortcoming, the radiation safety program data warehouse system was modified, and an automatic summary report showing collective sub-licensee maximum possession authorizations was created. But this report did not effectively present the summary information in a manner that key stakeholders could readily comprehend, as the data was not referenced to collective institutional possession limits. So a graphic version of the summary report was created wherein, for each isotope possessed, the collective institutional limit was displayed, along with the totals of all the individual sub-licensee maximum possession limits and current amounts on hand. This simple graphic served to effectively communicate the current status of the institution’s radiation source inventory to the radiation safety committee, executive management, and state regulatory officials. The effort has served to simplify the sometimes-complicated source inventory control process and has facilitated subsequent program reviews. In the future, the method is expected to assist the radiation protection program in anticipating when broad license amendments may be needed to accommodate operational changes.