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ED Clinicians Often Overlook Victims of Domestic Abuse


More than three quarters of domestic violence victims who report the incidents to police seek health care in EDs, according to a study, but most of them are never identified as victims of abuse during their hospital visits.

These findings, from a new University of Pennsylvania School of Medicine study, point to a missed opportunity to intervene and offer help to women who suffer violence at the hands of their intimate partners.

“Emergency departments are a safety net for women with health issues of all kinds, but our study shows we’re not doing a good enough job of assessing our patients’ entire situation,” said Karin V. Rhodes, MD, MS, director of Penn’s Division of Emergency Care Policy Research in the department of Emergency Medicine.

“There is no reason in the age of information technology that we should not provide routine screening and referrals to the social services patients can use to protect themselves from future violence.”

The findings, published online this week in the Journal of General Internal Medicine, revealed that women who reported domestic assaults to the police relied heavily on EDs for medical care: Nearly 80% came to an ED at least once during the four years after their assault, with an average of seven visits in that span.

Although hospitals typically have policies requiring screening and intervention for domestic violence, only 28% of the patients studied were ever identified as victims of abuse. That’s likely because most visits, 78%, were for medical complaints rather than injuries associated with the violence.

Only 3.8% of the ED visits involved a chief complaint of assault, which the authors say underscores the importance of screening patients who do not appear at risk.

The authors conducted a longitudinal cohort study that cross-checked court, police and emergency department records in a semi-rural county in Michigan between 1999 and 2002.

The data showed that when abuse was identified, ED staff provided legally useful notes in the patient’s chart 86% of the time and communicated with police about half the time. However, those steps didn’t always lead to interventions to actually protect the women — fewer than 35% of cases in which abuse victims were identified, contained any documented assessment of whether the patient had a safe place to go after discharge from the hospital.

Nor were hospital personnel consistent in referring victims to community-based domestic violence resources; that occurred only 25% of the time. Since healthcare workers have limited resources to devote to interventions for domestic violence, the authors point out the need to take a cross-systems approach.

Among strategies Rhodes and her coauthors suggest to boost the identification of women who have been abused: Confidential patient portals in which patients can use the Internet to link to their medical record and communicate with their providers, and development of easy-to-access interventions for victims, such as the on-site programs used to help patients with substance abuse and mental health problems. Integrated databases linking hospitals, criminal justice and social service agencies also could increase identification and tracking of abuse and use of support services.


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