An Evaluation of a System‐change Training Model to Improve Emergency Department Response to Battered Women

Abstract

Abstract. Objectives: To evaluate a system-change model of training from the Family Violence Prevention Fund and the Pennsylvania Coalition Against Domestic Violence for improving the effectiveness of emergency department (ED) response to intimate partner violence (IPV). Methods: An experimental design with outcomes measured at baseline, 9-12, and 18-24 months post-intervention. Twelve hospitals in Pennsylvania and California with 20,000-40,000 annual ED visits were randomly selected and randomly assigned to experimental and control conditions. Emergency department teams (physician, nurse, social worker) from each experimental hospital and a local domestic violence advocate participated in a two-day didactic information and team planning intervention. Results: The experimental hospitals were significantly higher than the control hospitals on a staff knowledge and attitude measure (F = 5.57, p = 0.019), on all components of the ''culture of the ED'' system-change indicator (F = 5.72, p = 0.04), and in patient satisfaction (F = 15.43, p < 0.001) after the intervention. There was no significant difference in the identification rates of battered women (F = 0.411, p = 0.52) (although the linear comparison was in the expected direction) in the medical records of the experimental and control hospitals. Conclusions: A system-change model of IPV ED training was effective in improving staff attitudes and knowledge about battered women and in protocols and staff training, as well as patient information and satisfaction. However, change in actual clinical practice was more difficult to achieve and may be influenced by institutional policy. Key words: domestic violence; model; system; training; intimate partner violence; battered women; public health. ACADEMIC EMERGENCY MEDICINE 2001; 8:131-138 S INCE Stark and colleagues' 1 class study of battered women in the emergency department (ED), several studies have documented significant proportions of female patients in the ED as abused. Intimate partner violence (IPV) is a major cause of both injury and non-injury visits to the ED by women.2-5 As reported in a prior article, the prevalence of IPV in this sample of women aged 18 years and older was 2.2% for acute trauma from abuse (15% for past-year physical or sexual IPV

“Between me and the computer”: Increased detection of intimate partner violence using a computer questionnaire

“…However, there was no increase in the overall rate of identification of battered women. 52 This could be because the main barrier to identification is not staff knowledge or attitudes but a system that overburdens providers and does not provide an environment conducive to sensitive discussions. Controlling for demographic factors, disclosure of victimization and perpetration in our study was associated with several psychosocial risk factors.…”

Intimate Partner Violence: What Are Physicians' Perceptions?

“…[25][26][27][28][29] In addition, having a system-wide approach for managing IPV victims with on-site or easily accessible IPV referrals, like the Kaiser system, improves IPV management by providers. 30 One site that was part of a network of clinics, discussed the ease of managing their patients with alcohol problems because they had an on-site alcohol counselor.…”

Assessment of Human Patient Simulation-Based Learning

“…Some are context specific, such as performance in an operating room, 33 during neonatal resuscitation, 34 during simulated obstetrical emergencies, 35 and in response to intimate partner violence, 36 while other instruments can be used to assess performance in general clinical simulations or practice. [37][38][39] Two nonclinical instruments have been used to assess the impact of a training program on emergency room physicians and nurses.…”