Hospital Security Searches Among Patients With Substance-Related Encounters.

Abstract

Importance: Hospital clinicians may request that security personnel search patients' rooms and belongings in response to suspected possession or use of illicit substances. Although searches are intended to protect patient and employee safety, little is known about search outcomes or consequences for clinical care.

Objective: To investigate the clinical context and outcomes of room searches among patients with substance-related hospital encounters.

Design, setting, and participants: Retrospective cohort study of security incident reports and electronic health record data for patients with substance-related hospital encounters between July 2021 and July 2023 at an urban, academic hospital with approximately 1000 beds in Philadelphia, Pennsylvania. Participants were adults with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes consistent with substance use disorders, chief concerns of drug overdose or withdrawal, and/or positive verbal screenings for opioid use who had emergency department visits or inpatient hospitalizations.

Main outcomes and measures: Primary outcomes were search requests, items confiscated, and patient-directed discharges (PDDs). Secondary measures centered on the clinical context of searches, including location and receipt of medications for opioid use disorder.

Results: There were 13 827 total substance-related hospital encounters over the study period involving 6985 unique patients (median [IQR] age, 47 [34-58] years; 3863 [55.3%] male; 3688 [52.7%] Black; 302 [4.3%] Hispanic; 2597 [37.2%] White). Over this time, security reported 576 room search requests, among which 457 (79.3%) were requests for searches among patients with substance-related hospital encounters. Nurses requested most searches (376 searches [82.3%]), and 195 searches (43.6%) resulted in no items confiscated. Confiscated items included syringes and unspecified paraphernalia (129 searches [28.9%]), confirmed or suspected drugs and alcohol (102 searches [22.8%]), tobacco products (54 searches [12.1%]), and pipes and smoking materials (53 searches [11.9%]). Patients who had 1 or more search requests during a substance-related hospital encounter had a statistically significant odds ratio (OR) of having a PDD compared with patients who did not undergo searches (OR, 2.99; 95% CI, 2.32-3.86).

Conclusions and relevance: In this cohort study of patients with substance-related hospital encounters, most searches did not result in the confiscation of illicit substances, and searches were associated with PDDs. There is an overall need for clear, patient-centered hospital search protocols that support both staff and patient well-being.