Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objectives: We aimed to assess the impact of metal detectors on patients’ feelings of safety in the ED.

Background: National guidelines recommend hospitals attempt to prevent weapons from entering EDs. Metal detectors have been shown to reduce the number of weapons coming into EDs. However, there are concerns that they are unwelcoming to patients and might discourage them from seeking care. Less than one third of hospitals in the United States utilize metal detectors. The most recent ED based studies of patients’ attitudes towards metal detectors were over 25 years ago, and patients’ perceptions of safety likely have evolved during this time.

Methods: We surveyed a convenience sample of patients and their companions >18 years of age, who had undergone metal detection at the entrance of our suburban, academic ED from 2019-2021. Using tailored design, we developed survey questions with a consensus panel of physicians, nurses, and patients. We pilot tested the survey with cohorts of medical students and patients. Respondents anonymously reported their answers to questions on a 5 point Likert scale online in Qualtrics. Descriptive statistics were calculated, and chi square tests were utilized to compare groups.

Results: The survey response rate was 78%, with 303 patients completing the survey. Most (71%) non-respondents were due to clinical care needs preventing participation. Approximately two thirds of participants were patients (67%) and female (61%) with nearly all respondents in the ED for non-traumatic concerns (83%). Nearly one third of respondents (31%) had a colleague or family member that had been the victim of physical assault, 16% had previously witnessed physical violence in the ED, and 29% had a weapon in their home. An abundance (91%; 95% CI: 87 – 94%) of respondents reported that metal detectors improved their sense of safety in the ED. Slightly over half of respondents (52%; 95% CI: 46 – 58%) indicated the presence of metal detectors made them more likely to visit an ED in the future. A small proportion (5%; 95% CI: 3 – 8%) indicated people should be allowed to bring weapons into the ED. Nearly one fifth of respondents reported metal detectors were somewhat or very inconvenient (19%; 95% CI: 15 – 24%) or somewhat or very much limited their privacy (21%; 95% CI: 16 – 26%). For respondents that reported a concern about privacy or inconvenience, over two thirds still favored having metal detectors (71%; 95% CI: 55 – 84%). There were no significant differences between respondents about metal detectors based on age, education, gender, race, prior exposure to violence, or personal ownership of weapons.

Conclusion: In this single center study, patients and their companions reported feeling safer with metal detectors in the ED, despite modest concerns about their impact on convenience and privacy. These results are similar to much smaller studies from 25 years ago.