Wanberg, Erik J

Importance Hospital-based shootings represent an extreme form of workplace violence, with notable consequences for staff, patients, and visitors. Despite growing concern, these events remain poorly understood. Objective To categorize hospital-based shootings from 2012 to 2024 and incorporate prior published events between 2000 and 2011 to examine trends in shootings over a 25-year span. Evidence Review Events in this systematic review of acute care hospital–based shootings in the US from January 1, 2012, through December 31, 2024, with subgroup analysis of previously published data trending shootings over 25 years (January 1, 2000, through December 31, 2024), were identified using EBSCO Regional Business News, ProQuest US Newsstream Collection, Gun Violence Archive, and Google News Search. Selected shooting events involved at least 1 injured person (a nonperpetrator or perpetrator) that occurred within or on the immediate property of the hospital. Findings A total of 327 news articles of unique hospital-based shooting events (5.2 per year per 1000 hospitals) were included from a review of 6658 articles, spanning 47 US states (94.0%). There was an overall incidence of 25.2 hospital-based shootings per year. Between 2012 and 2024, shootings increased by a mean (SD) of 1.7 (0.5) events per year, from 14 to 34 events (8.4% increase per year). Large hospitals accounted for the highest rate of shootings (258.1 events per 1000 hospitals). Events primarily occurred in urban settings (314 [96.0%]), and 161 (49.2%) occurred in the US South. Nearly one-third (105 [32.1%]) were potentially preventable by weapons screening. From 2000 to 2024, shootings increased by a mean (SD) of 1.1 (0.2) events per year, from 6 to 34 events (6.4% increase per year). A positive correlation was found in annual firearm fatalities in hospital settings and US firearms fatalities overall between 2012 and 2023 ( r = 0.42). Conclusions and Relevance This systematic review found that hospital-based shootings in the US have increased steadily over the past 25 years, representing an intersection between broader national trends in workplace and firearm violence. Large hospitals, those in the US South, and hospitals in urban communities are particularly at-risk settings. These findings underscore the need for hospital-specific prevention strategies, including consideration of weapons screening technology, alongside broader societal efforts to address rising firearm violence.

Abstract Rationale: Medical trainees are often involved in the care of hospitalized patients, yet there are minimal data about correlation of trainee involvement with outcomes for patients with rapid response team (RRT) activations. Methods: This was a retrospective single-center review of adult patients on a primary medicine service who had an RRT activation between January 1, 2023 and December 31, 2023. This study was approved by our hospital institutional review board. Patients were included if they were at least 18 years old and had a hospitalization with an RRT activation. Outcomes analyzed included transfer to the ICU, 90-day mortality, and goals of care discussions. A subset analysis was performed of patients who remained on the floor after RRT. Statistical analysis was performed with Pearson's chi-square and Kruskal-Wallis tests. Results: We analyzed 1686 adult patients who had an RRT activation within the study timeframe. Mean age was 67.3 years (SD 16.8), 792 (47.0%) were female, and 1489 (88.3%) identified as white. Trainees were involved with 1016 (60.3%) patients; 935 of these were on an internal medicine team and 81 were on a family medicine team. Patients were more likely to transfer to the ICU if they were on a primary floor team with trainee involvement (p = 0.006). There was no difference in goals of care discussion occurrence prior to RRT (p = 0.257) or 90-day mortality (p = 0.877). Subset analysis of patients who remained on the floor after RRT was performed. There was no difference in occurrence of goals of care discussions after RRT (p = 0.169), code status change (p = 0.237), or transition to comfort care (p = 0.381) for patients on teams with trainee involvement and those without. Of the 925 patients who remained on the floor after RRT, goals of care discussion occurred after RRT in 210 (22.7%). Conclusions: In this study, we demonstrate that trainee involvement does not correlate with occurrence of goals of care discussions either before or after RRT activations. Trainee involvement also does not correlate with 90-day mortality for patients with decompensation events. However, patients on teams with trainee involvement are more likely to transfer to the ICU as the result of an RRT activation. It is possible that this reflects the increased complexity of patients who are admitted to teaching services; however, further investigation is needed.