title: The impact of a sexual assault/domestic violence program on ED care.
abstract: BACKGROUND
  Examination and management of the sexually assaulted patient comprise a complex task. On-call nurses with advanced training are used in some hospitals, but their impact on patient care and appropriate forensic examination is largely unknown. We evaluated the impact of the introduction of a sexual assault/domestic violence program (SADVP) on ED flow, comprehensive patient care, and collection of forensic evidence.
  
  
  METHODS
  Patients presenting to the 2 emergency departments in the Kingston area (Ontario, Canada) (population, 250,000) after sexual assault were compared during 2 time periods: (1) before SADVP implementation (January 2001 through August 2004) and (2) after SADVP implementation (September 2004 to August 2006). ED, hospital discharge, SADVP, and police records were reviewed. Data abstraction included patient demographics, assault characteristics, forensic examination results, and treatment protocols.
  
  
  RESULTS
  The incidence of patients presenting with a complaint of sexual assault doubled (61 cases before SADVP implementation and 92 cases after SADVP implementation). Median times to initial clinical evaluation were lower in the post-SADVP group (20 minutes vs 33 minutes, P = .04). Patients in the post-SADVP group reported less vaginal/anal penetration (77% vs 98%, P < .001) and had fewer genital injuries (13% vs 39%, P = .007); other sexual assault characteristics were similar between the 2 study periods. Forensic kits were completed more often in the post-SADVP group (77% vs 66%, P = .18). Pregnancy and sexually transmitted disease prophylaxis was offered more consistently after SADVP implementation (98% vs 85%, P = .007), as was counseling (100% vs 95%, P = .06).
  
  
  CONCLUSIONS
  The profile of patients observed after SADVP implementation changed to include less stereotypical sexual assaults. Introduction of the SADVP decreased wait times for sexually assaulted patients, despite the need for the on-call nurses to attend the emergency department. This program also showed higher completion on a number of important indicators of quality of care: forensic kits, counseling, and pregnancy and sexually transmitted disease prophylaxis.
authors: Department of Emergency Medicine, Queen's University,76 Stuart Street, Kingston, Ontario, Canada. karisampsel@hotmail.com
authors: Kari
authors: K
authors: Sampsel
authors: Luke
authors: L
authors: Szobota
authors: Donna
authors: D
authors: Joyce
authors: Karen
authors: K
authors: Graham
authors: William
authors: W
authors: Pickett
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D053604:Forensic Nursing / Q000379:methods; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012742:Sex Offenses; D013179:Spouse Abuse / Q000175:diagnosis*; D055815:Young Adult