Many Domestic Abuse Victims are Undetected in Emergency Departments

More than three out of four victims of domestic violence who report the abuse go to emergency departments to seek medical care. Yet, 72 percent of them are never identified as abuse victims, according to a University of Pennsylvania School of Medicine study. As a result, clinicians often miss crucial opportunities to intervene on their behalf.

The study, conducted over four years, looked at eight emergency departments, twelve police jurisdictions, and the prosecuting attorney’s office in a semi-rural county in the Midwest. The study showed that women who report domestic assaults to the police rely heavily on emergency departments for medical care. In fact, almost 80 percent of the victims studied visited an emergency department at least one time during the four years after their assault. Most of them sought care an average of seven times. Only 28 percent of the victims studied were identified as domestic abuse victims despite the fact that most hospitals routinely screen for domestic abuse. This may be because most women presented with medical complaints. Less than 4 percent cited assault as a chief complaint―a statistic that underlines the need to screen all patients, even those who may not appear to be at risk for domestic violence.

Ineffective Screening

Earlier studies reveal that up to 20 percent of women seen in the ED are victims of domestic violence. Still, universal screening in emergency departments continues to be ineffective.

So what factors influenced the clinician’s ability to spot domestic abuse victims? According to the University of Pennsylvania study, domestic violence was four times more likely to be detected when victims visited emergency departments on the same day that an incident had been reported to the police and when the police brought the victim to the hospital. Even though victims rarely listed domestic violence as their chief complaint, clinicians were more likely to identify these victims when their chief complaint involved mental health or substance abuse problems.

In cases where victims of domestic abuse were identified, ED staff provided legally useful notes in 86 percent of the incidences and communicated with police approximately 50 percent of the time. These actions, however, did not always result in interventions that protected victims. Fewer than 35 percent of cases in which patients were identified as abuse victims contained any documentation about whether patients had safe environments to return to after discharge. Only 25 percent of the abuse victims were referred to community-based domestic violence resources.

Better Strategies

The study proposed these strategies to help clinicians increase the likelihood of identifying abuse victims:

  • Make confidential portals available so patients can use the Internet to link to their medical record and communicate with health care providers.
  • Develop easy-to-access interventions for victims similar to onsite programs for patients with substance abuse or mental health problems. 
  • Create integrated databases that link hospitals with criminal justice and social service agencies to improve identification and tracking of domestic abuse victims and increase the use of support services. 

To learn more about how to recognize victims of domestic abuse, look into Mosby’s online Emergency Nursing Orientation 2.0 course or call 800-999-6274.

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