Development and validation of an emergency department screening and referral protocol for victims of domestic violence.
OBJECTIVE
To describe the development, design, and validation of an emergency department protocol for the identification, documentation, and referral of victims of domestic violence.


METHODS
We based protocol development and design on a departmental needs assessment. The validation component involved the screening of women 16 years and older treated in the ED during a 2-week period at both triage (stage 1) and nursing assessment (stage 2). Sensitivity and specificity of the triage screen were determined.


RESULTS
The departmental needs assessment revealed several important limiting factors that motivated the design of the protocol. In response, the protocol design included a two-stage screening process, stage 1 taking place at triage and stage 2 as part of the nursing assessment. During the 2-week validation study, 595 women 16 years and older were treated in the ED, but complete two-stage screening data were obtained for only 114 (19%). Of the patients who were appropriately screened, eight screened positive at stage 1 and two of the eight were confirmed at stage 2. Two additional cases were identified at stage 2 in whom violence had not been suspected at stage 1. Triage screen sensitivity was 50%, specificity 95%. Of the women properly screened at both stages, 3.5% were identified as victims of domestic violence.


CONCLUSIONS
We identified many obstacles to implementation of an ED domestic violence screening and referral protocol, demonstrating that evaluation is imperative in determining actual clinical impact.
Waller
A E
AE
University of North Carolina School of Medicine, Department of Emergency Medicine, Chapel Hill, USA.
Hohenhaus
S M
SM
Shah
P J
PJ
Stern
E A
EA
D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D017579:Domestic Violence / Q000517:prevention & control*; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D009730:Nursing Assessment; D015397:Program Evaluation; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012947:Social Work; D014218:Triage