Three in Four Women Who Experience Abuse Go Unidentified as Abuse Victims in ERs
Apr 11, 2011
When women who have made police reports of intimate partner violence in the recent past seek medical care at emergency departments, nearly three-fourths of them are not identified by medical personnel as abuse victims, according to a study published in the March 15 issue of the Journal of General Internal Medicine. In most cases, women in the study sought medical care in the emergency department for reasons unrelated to the abuse, but effective screening could have – and usually did not – identify them as victims of abuse. That led the study authors to conclude that emergency departments’ assessment practices for intimate partner violence victims are “ineffective,” and that health care professionals need to more aggressively assess patients for domestic abuse or risk, even when they seek treatment for other issues.
“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 one of the study’s authors, Karin V. Rhodes, M.D., M.S., director of the Division of Emergency Care Policy Research in the Department of Emergency Medicine at the University of Pennsylvania’s Schools of Medicine and Social Policy and Practice. “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 study “Intimate Partner Violence Identification and Response: Time for a Change in Strategy” looked at police, prosecutor and medical record data from 1999 to 2002 in a semi-rural Midwestern county. Researchers found that over the four-year period, 993 partner violence victims generated 3,426 police incidents related to abuse. But while nearly 80 percent of the women went to an emergency department after the date of the reported incident, the vast majority went seeking treatment for a medical complaint not associated with the violence they experienced and 72 percent of them never were identified as victims of abuse.
Although hospitals typically have policies requiring assessment and intervention for domestic violence, only 3.8 percent of the emergency room visits of the 993 women involved a chief complaint of intimate partner violence, and only 28 percent of the women ever were identified as victims of abuse. Study authors say that the findings underscore the importance of systematically assessing patients even if they don’t appear to be at risk.
Intimate partner violence was more likely to be identified when the emergency room 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.
The authors’ conclude that the “vast majority of police-identified women victims of intimate partner violence are using the emergency department for health care, but providers are missing important opportunities to identify and provide interventions for intimate partner violence.”