Improving domestic violence screening practices in the emergency department: an Australian perspective

Abstract

IntroductionDomestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular.ObjectiveTo examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV.MethodsEmergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening.ResultsIn total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were ‘very or severely limiting’ for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen.ConclusionThis study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.

Identifying domestic violence and sexual assault presentations at a regional Australian hospital emergency department: Comparative analysis of domestic violence and sexual assault cases

“… 31 Inadequate DV education may limit a clinician’s ability to assess a patient’s situational danger, make safety plans or confidently complete necessary reports. 31 …”

“…31 Inadequate DV education may limit a clinician's ability to assess a patient's situational danger, make safety plans or confidently complete necessary reports. 31 Our study highlighted the prominence of mental health issues among women presenting with DV and SA. These issues included disorders such as depression, anxiety, personality disorder, anorexia and suicidal ideation.…”

“… 30 Despite the general positive view of DV screening among ED clinicians, low screening rates are consistently seen in EDs throughout Australia, particularly in regional locations. 19 , 31 , 32 …”

“…30 Despite the general positive view of DV screening among ED clinicians, low screening rates are consistently seen in EDs throughout Australia, particularly in regional locations. 19,31,32 For victims, there are coexisting long-term mental and physical health consequences of DV. 6,33 Women experiencing DV are more likely to visit health professionals and report higher rates of health issues than women not experiencing DV.…”

“If Not Me, Then Who?”: Exploring the Challenges Experienced by Front-Line Clinicians Screening for, and Communicating About, Domestic Violence in the Emergency Department

“…This research found that classifications of IPV were too high, and the other instances of significant injury were being missed, thereby negating the possibility of specialist interventions. Diagnostic thresholds may differ, but assumptions in recognition also reveal differences in psychological constructs associated with DV identification, a key example being the differences between survivors of IPV noting that fear impeded any intention to disclose, in contrast with ED nurses who were more likely to say that a victim was in "denial" (Watt et al, 2008) The quality of interaction with other healthcare team members-within and outside of the ED-is noted to facilitate screening and management of DV, with cooperation and willingness to screen as a team rather than just as individuals being cited as a key enabler (Sweeny et al, 2023;Zijlstra et al, 2017). The notion of developing a "culture" of screening, however, was found to be fraught with tensions surrounding the expectations of high patient turnover at busy times, and ultimately recommend a protocol within that research setting.…”