More than three quarters of domestic violence victims who report the incidents to police seek health care in emergency rooms, but most of them are never identified as being victims of abuse during their hospital visit.
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 an intimate partner.
“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 emergency rooms for medical care: Nearly 80 percent came to an emergency room at least once during the four years after their assault. Most of those sought ED care frequently – an average of seven times each. Although hospitals typically have policies requiring screening and intervention for domestic violence, only 28 percent of the patients studied were ever identified as victims of abuse. That’s likely because most visits (78 percent) were for medical complaints, not injuries associated with the violence. Only 3.8 percent of the ED visits involved a chief complaint of assault, which the authors say underscores the importance of screening patients who don’t appear to be at risk.
Previous studies have shown that as many as 20 percent of women have been victims of domestic violence in the past year, but moves toward universal screening in emergency departments have yet to be shown to be effective. To better focus on how often – and how – victims are identified when they come to the emergency room, the study 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 authors found that intimate partner violence was more likely to be identified when the ED visit occurred on the day of the police incident – assaults were four times more likely to be revealed at this point – and when patients were transported to the hospital by police. Providers were also more likely to identify abuse among patients whose chief complaints involved mental health or substance abuse issues such as suicidal behavior or overdoses.
The data showed that when abuse was identified, ED staff provided legally useful notes in the patient’s chart 86 percent 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 percent of cases where abuse victims were identified, contained any documented assessment of whether the patient has a safe place to go after discharge from the hospital. Nor were they consistent in referring victims to community-based domestic violence resources – that occurred only 25 percent of the time. Since health care workers have limited resources to devote to interventions for domestic violence, the authors point out the need to take a cross-systems approach to make it easier for providers to do the right thing.
“Most hospitals have a social work infrastructure to counsel patients with social risks and assist them in linking to needed services, but our study shows that these resources are infrequently utilized. This may be due to the fact that social workers are not always readily available in the ED,” Rhodes said. “As providers, we should strive to set up our health care system to present every patient with an opportunity to feel safe and supported in disclosing instances of abuse and give them information and resources that can help.”
Among strategies Rhodes and her coauthors suggest to boost the identification of women who’ve been abused: Use of confidential patient portals in which patients could 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 could also increase identification and tracking of abuse and use of support services.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4 billion enterprise.
Penn's School of Medicine is currently ranked #2 in U.S. News & World Report's survey of research-oriented medical schools and among the top 10 schools for primary care. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $507.6 million awarded in the 2010 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania â€“ recognized as one of the nation's top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital – the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2010, Penn Medicine provided $788 million to benefit our community.
Holly Auer | EurekAlert!
The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
High-precision measurement of the g-factor eleven times more precise than before / Results indicate a strong similarity between protons and antiprotons
The magnetic moment of an individual proton is inconceivably small, but can still be quantified. The basis for undertaking this measurement was laid over ten...
Heat from the friction of rocks caused by tidal forces could be the “engine” for the hydrothermal activity on Saturn's moon Enceladus. This presupposes that...
The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.
Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....
The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.
Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...
Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.
That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...
15.11.2017 | Event News
15.11.2017 | Event News
30.10.2017 | Event News
24.11.2017 | Physics and Astronomy
24.11.2017 | Health and Medicine
24.11.2017 | Earth Sciences