Improving the Quality of Care of Women in the Emergency Department: A survey of battered women

Abstract

Study Objectives: Domestic Violence (DV) is a problem defined as physical, sexual, and/or mental abuse used by one person in a relationship in order to gain control over the other. Over 10 million in the US will experience DV, and 34% will seek medical care for their injuries. The Joint Commission, the American College of Emergency Physicians, and the US Preventive Services Task Force strongly encourage screening for DV. However, only 30% of women who present to the Emergency Department (ED) are screened. To gain better understanding of patient screening and treatment in the ED, we conducted a pilot survey of DV patients in a shelter, seen in an ED.  Methods: The survey was conducted during the women's initial visit to Sojourner Family Peace Center in Milwaukee, WI. It includes 22 questions measuring responses of women’s encounters with screening and treatment for DV in the ED.  Results: Sojourner collected 24 surveys over 7 months. Thirteen women presented for treatment of injuries related or not related to abuse. Problems with abuse-related care they received were identified. For example, 31% of women presenting with obvious signs of abuse, such as human bite wounds or head injury, were not screened. Four of 11 women were screened with family or law enforcement present. Nine of 11 were screened by a nurse, social worker, or police officer, not a physician. Four women felt rushed by healthcare professionals and that they did not genuinely care. Most noticeably, women were not screened at all.  Conclusion: We gained valuable insight on interactions between healthcare personnel and DV victims. DV screening must be done with no family present. Removing law enforcement from rooms is noted to make women feel more comfortable. If a family member is adamant about remaining with the patient, the patient can be removed for a blood draw or sensitive exam to attain privacy. Standardizing screening could aid in making DV victims feel less rushed and more at ease. The courageous women sharing personal stories help pave the way to better treatment for future victims of DV presenting to the ED. Â

Keywords

• domestic violence
• emergency medicine