Objective-To determine the effect of restricting extensions to permitted licensing hours on the numbers of alcohol or assault related attendances at an inner city accident and emergency (A&E) department. Methods-Prospective data collection on consecutive attendances between 17.00 and 09.00 h during three study periods: two weeks before the introduction of the restriction, two weeks immediately afterwards, and for a two week period beginning five weeks after the change. Blood alcohol concentration was measured with a pocket alcohol meter. Results-Overall 56.5% of patients (n = 2836) provided a breath sample, and 28.9% (819) were positive. The proportion of patients testing positively peaked between 02.00 and 04.00 h. A very high proportion of assault cases who were tested (260) were positive (67.3%). Assault cases comprised 19.1% of all attendances between 24.00 and 04.00 h. No significant changes in the pattern of alcohol or assault related attendances followed the restriction in extensions to permitted licensing hours. Conclusions-A policy of uniform closing times of licensed premises does not influence the profile of alcohol or assault related attendances at an inner city A&E department. (7AccidEmergMed 1998;15:23-25)

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Introduction: Alberta has one of the highest rates of domestic violence (DV) in the country. Emergency departments (EDs) and urgent care centres (UCCs) are significant points of opportunity to screen for DV and intervene. In Alberta, the Calgary Zone began a universal education and direct inquiry program for DV in EDs and UCCs for patients > = 14 years in 2003. The Calgary model is unique in that (a) it provides universal education in addition to screening and (b) screening is truly universal as it includes all age groups and genders. While considering expanding this model provincially, we engaged in the GRADE Adolopment process, to achieve multi-stakeholder consensus on a provincial approach to DV screening, as herewith described. Methods: Using GRADE, we synthesized and rated the quality of evidence on DV screening and presented it to an expert panel of stakeholders from the community, EDs, and Alberta Health Services. There was moderate certainty evidence that screening improved DV identification in antenatal clinics, maternal health services and EDs. There was no evidence of harm and low certainty evidence of improvement in patient-important outcomes. As per Adolopment, the expert panel reviewed the evidence in the context of: a) values and preferences b) benefits and harms, and c) acceptability, feasibility, and resource implications. Results: The panel came to a unanimous decision to conditionally recommend universal screening, i.e., screening all adults above 14 years of age in EDs and UCCs. By conditional, the panel noted that EDs and UCCs must have support resources in place for patients who screen positive to realize the full benefit of screening and avoid harm. The panel deemed universal screening to be a logistically easier recommendation, compared to training healthcare professionals to screen certain subpopulations or assess for specific symptoms associated with DV. The panel noted that despite absence of evidence that screening would impact patient-important outcomes, there was evidence that effective interventions following a positive screen could positively impact these outcomes. The panel stressed the importance of evidence creation in the context of absence of evidence. Conclusion: A GRADE Adolopment process achieved consensus on provincial expansion of an ED-based DV screening program. Moving forward, we plan to gather evidence on patient-important outcomes and understudied subpopulations (i.e. men and the elderly).