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Objective. To determine the acceptance by family members regarding nontransport of patients in cardiac arrest following unsuccessful resuscitation occurring in private residences. Methods. This was a survey with a structured telephone interview. Inclusion criteria included adult patients in asystolic nontraumatic cardiac arrest. The setting was an urban multitiered emergency medical services (EMS) system. Termination of field resuscitation efforts was authorized by an emergency medicine physician at a medical control base station after set protocol criteria. Support services were provided by trained personnel. Results. Thirty-three follow-up interviews were completed with a family member. Thirty-two (97%) of the contacted family members expressed satisfaction with the services provided by EMS personnel. Twenty-one (64%) patients were not transported to the hospital. All 21 family members of the nontransported were satisfied with both the medical care and the emotional support provided by EMS. Additionally, family members of three of the 12 (25%) transported patients stated they would have preferred to have the patient die at home instead of being transported. Conclusions. In this small sample, family members accept the nontransport of patients by trained EMS personnel after asystolic nontraumatic cardiac arrest occurring in private residences. This may positively impact emergency department resources for other critically ill patients.

Study Objectives This study assesses VA mental health providers’ understanding of intimate partner violence (IPV) and the perception of patient benefit of routine inquiry and service referral. The impact of an instructional curriculum was also examined following an interactive training. Methods An evidence-based curriculum was offered to VA mental health providers. The curriculum utilized didactic methods, case scenarios, and resources regarding referrals and statutes regarding crimes related to violence and abuse. The participants completed pre- and post-training surveys to assess their perceptions about IPV and to evaluate the training. Results Seventy-three individuals completed the training. Fifty-four of the participants were female, and thirty-three were over the age of 45. Fifty-one individuals completed both surveys. There were no differences between participants’ views of the seriousness of IPV in the community or their practices before or after the training. However, participants scored significantly higher on the knowledge and efficacy measures after the training (p<.001). Conclusion Following an educational intervention, providers demonstrate more knowledge and efficacy regarding routine inquiry and referral for IPV. Barriers to universal implementation still warrant attention.

Little work has explored the extent to which female victims of intimate partner violence use medical and legal services. In this cross-sectional study of a sample of women seeking orders of protection at family court (N = 95), we report descriptive, self-report data on health care utilization and insurance coverage. Although 85% of the petitioners had private or public health insurance, 39% reported delayed medical care, and 14% had not obtained medical care of any kind. The response to address interpersonal violence victimization should attempt to connect women using the courts with needed health care services.

Students learn to perform desired interviewing skills more frequently when they have the benefit of guided discussion, practice, and memory aids.

BackgroundMany physicians do not routinely inquire about intimate partner violence.PurposeThis qualitative study explores the process of academic detailing as an intervention to change physician behavior with regard to intimate partner violence (IPV) identification and documentation.MethodA non-physician academic detailer provided a seven-session modular curriculum over a two-and-a-half month period. The detailer noted written details of each training session. Audiotapes of training sessions and semi-structured exit interviews with each physician were recorded and transcribed. Transcriptions were qualitatively and thematically coded and analyzed using Atlas ti®.ResultsAll three study physicians reported increased clarity with regard to the scope of their responsibility to their patients experiencing IPV. They also reported increased levels of comfort in the effective identification and appropriate documentation of IPV and the provision of ongoing support to the patient, including referrals to specialized community services.ConclusionAcademic detailing, if presented by a supportive and knowledgeable academic detailer, shows promise to improve physician attitudes and practices with regards to patients in violent relationships.

This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.