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De-Escalation Tatics at the Point of Entry
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De-Escalation Tactics at the Point of Entry 
Debbie Ream, MS, MA, RN; Carla Weber, MS, CCNS, RNC


Doris E. Gleason Publications Award badge Entry into a healthcare system can be a scary situation for much of the general population. Patient Access professionals are often the first point of contact for patients and families. In these situations, understanding common patient fears — whether known or unknown, explicit or implicit — can have a great impact on crisis prevention and management.


Fears presented on admission could be facing a diagnosis, effects on employment, unable to care for loved ones, financial concerns and loss of daily function, just to name a few. Normal reactions to fear can present as anger, sadness, inability to communicate effectively and other stress responses. Behaviors can also be affected by family dynamics, confusion, wait times, pain levels or any other stress contributing to their personal life at the time of check-in. Untreated mental illness is a growing concern and can affect coping and reactions during a health crisis that are initially encountered by Patient Access professionals. All of these factors contribute to the overall patient experience, where Patient Access professionals are oftentimes the first point of contact for a patient that is experiencing fear or anxiety upon entering a hospital or healthcare facility.


It is important to note that the incidence of serious workplace violence are almost four times more common in healthcare settings versus private industry. In 2013, 80 percent of serious violent incidents were caused by interactions with patients. Other incidents were caused by visitors or coworkers. Behaviors or communication that can escalate behavior responses are:


  • Snappy retorts
  • Intolerance of complaints
  • Rushing
  • Ignoring requests for information
  • Failure to recognize physical or verbal signals
  • Overreaction to people or situations
  • Ignoring or minimizing threats

Please always be aware of your own actions as a Patient Access professional and how any of the above actions can cause adverse reactions from a patient or other staff members.

Although Patient Access professionals cannot anticipate every situation or encounter and how someone will respond, there are many ways that they can be prepared unexpected settings with the right training and information. Verbal techniques are an effective first-line defense that Patient Access professionals can use to help de-escalate 90 percent of escalating behaviors. Verbal and non-verbal responses that can be used by Patient Access professionals include:


  • Showing concern and respect
  • Using calm voice/language
  • Slowing down
  • Using soft speech
  • Validating concerns
  • Being non-judgmental
  • Limiting distractions
  • Focusing on changing the environment
  • Focusing on options and asking “what do you need?”
  • Avoiding “No” and responding with “Here is what we CAN do for you”
  • Providing a timeline for next steps in their healthcare experience
  • Being aware of patient and family limitations such as sight, ability to hear, ability to take in and understand multiple instructions and information

Patient Access professionals should learn to stay alert to help keep personal safety a priority while interacting with an escalating patient. Techniques that can help de-escalate behavior to promote safety include:


  • Observing behaviors for escalation
  • Maintaining a safe distance of two arm’s length between you and patient
  • Avoiding touching the patient without expressed permission
  • Allowing the patient time to calm down or time to vent
  • Walking away when feeling in danger

Learning and teaching these techniques for interacting with a patient that is escalating a situation — whether out of fear or other concerns — will help you and your Patient Access staff remain aware of and equipped to handle these scenarios. By meeting the patient with compassion, Patient Access professionals can honor their profession, the family and the patient during a vulnerable time of the human experience.


“If we could look into each other’s hearts and understand the unique challenges that each of us face, I think we would treat each other much more gently, with more love, patience, tolerance and care.” — Marvin Ashton.



  1. OSHA, Workplace Violence in Healthcare: Understanding the challenge, online Dec 2015; Bureau of Statistics.
  2. Andrews, Bart (2018). Tools and Strategies to Support Clinical Staff: Management of patients with behavioral challenges. Behavioral Health Response. Lecture at the Missouri Center for Nursing and Missouri Action coalition Annual Summit 2018. May 3-June1, 2018.

Debbie Ream is a SAFE Approach and MANDT instructor for Mercy Health System.


Carla Weber is director of clinical education for the central region at Mercy Health System.

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