Telephone Follow‐up for Case Finding of Domestic Violence in an Emergency Department

Abstract

Objective: To determine whether telephone follow-up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding. Methods: A prospective, cross-sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for D V injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting > I week. Attempts were made to telephone all patients who had high-risk presentations within 3 days of their emergency visits. Patients were contacted by a trained interviewer regarding the circumstances of their visits. Results: There were 142 (9%) high-risk presentations out of 1,500 ED visits by women. Of these high-risk visits, 68 patients denied DV, 19 patients did not speak English, 16 patients gave an incorrect telephone number, 18 patients could not be reached after 3 telephone calls, and 6 patients did not give a telephone number. Of the remaining 15 patients, 5 were diagnosed at the initial visit as having experienced DV, and 10 admitted on the follow-up call that the visit had been related to DV or emotional stress at home. Conclusion: A structured interview, conducted via telephone in follow-up of released ED patients, identified an additional 10 victims out of 142 high-risk presentations and 1,500 total ED presentations. This approach is labor-intensive, with a relatively low yield. Nonetheless, prospective identification of selective high-risk cases by physicians, coupled with subsequent social service telephone contact, may be a complement in department case finding.Key words: domestic violence; injury prevention; domestic assault; emergency department; social services. episode of DV.' While there is controversy about the estimated rates of DV among ED patients,6 there is agreement that obtaining a history of DV from victimized women patients can be difficult. It is estimated that health care providers diagnose DV 4% of the time it is present.' There are many reasons for this failure, including the provider's failure to ask the right questions and the patient's embarrassment or fear to give the right answers.'Experts in the field of family violence emphasize that, to make the diagnosis, there must be a structured interview in a safe and secure environment where the patient can feel comfortable.' Many EDs, especially those in urban areas with a high census and a high prevalence of injured and drug-abusing patients where DV is likely to be greatest," are the antithesis of the atmosphere needed to inspire patient confidence. Even with the best of training and intentions, many providers may not take the necessary unhurried history for potential DV given a crowded ED with a large backlog of patients to be seen. We experienced low rates of suspected DV documentation in our ...

Childhood Abuse and Later Medical Disorders in Women

“…This finding confirms previous reports showing headache to be associated with adult assault or domestic violence [54, 55]. One emergency room team has included complaints of headache, non-specific abdominal pain, generalised fatigue or numbness lasting for more than 1 week along with physical injury and straight psychological presentations as all showing a high likelihood of domestic violence [56]. …”

Detection of Domestic Violence by a Domestic Violence Advocate in the ED

“…The published literature has examined the efficacy of detecting the incidence of DV by the use of written surveys, computer-based surveys, and by screening conducted by health care professionals, including physicians and nurses. Comparing our results to published prevalence data (11.3-54.2% with written or computerized surveys and 10.9 -36.9% with interviews performed by various ED personnel), our results were found to fall within the same range as found in the published reports regardless of the method of detection (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…When compared with existing published acute incidence data (1-19% when obtained by written or computerized survey and 1-2.2% when obtained by interview), our results suggest a higher rate of detection than most previous reports of results obtained by personal patient interview (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…Although there is a good deal of existing literature on the prevalence and incidence of domestic violence, most of the previous studies have utilized a written survey or interviews by ED staff (registered nurse, physician assistant, or emergency physician) (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Recent advances: Accident and emergency medicine

“…A number of potential barriers to effective screening for domestic violence in emergency departments have been identified—insufficient education in recognising domestic violence, inadequate intervention on the part of nurses and doctors, lack of 24 hour social service coverage in emergency departments, and inability of staff to comply with protocols that are time consuming or complicated 21 – 23. Future areas of investigation include the development of sensitive and easily administered screening for domestic violence, the institution of formal education programmes aimed at health professionals working in emergency departments, and development of cost effective intervention and treatment protocols.…”