Safe Discharge Needs Following Emergency Care for Intimate Partner Violence, Sexual Assault, and Sex Trafficking

Abstract

Introduction For survivors of gender-based violence (GBV) seeking care in hospital emergency departments (ED) the need for medical care and safe discharge is acute. Methods In this study we evaluated safe discharge needs of GBV survivors following hospital-based care at a public hospital in Atlanta, GA, in 2019 and between April 1, 2020–September 30, 2021, using both retrospective chart review and evaluation of a novel clinical observation protocol for safe discharge planning. Results Of 245 unique encounters, only 60% of patients experiencing intimate partner violence (IPV) were discharged with a safe plan and only 6% were discharged to shelters. This hospital instituted an ED observation unit (EDOU) to support GBV survivors with safe disposition. Then, through the EDOU protocol, 70.7% were able to achieve safe disposition, with 33% discharged to a family/friend and 31% discharged to a shelter. Conclusion Safe disposition following experience or disclosure of IPV and GBV in the ED is difficult, and social work staff have limited bandwidth to assist with navigation of accessing community-based resources. Through an average 24.3 hours of an extended ED observation protocol, 70% of patients were able to achieve a safe disposition. The EDOU supportive protocol substantially increased the proportion of the GBV survivors who experienced a safe discharge.

“And then the person sort of just drops off the radar…”: barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta

“…In a sample ( n = 245) of hospitalized IPV survivors (97% women; mean age 37 years) discharged from a safety-net hospital in Atlanta in 2019 with sporadic CBO services in the hospital, 40% were discharged with no identified safe shelter (defined as discharge to a shelter, a family/friend, or known safe location without a perpetrator present); only 6% were discharged to placement in a shelter ( 25 ). In a related study during the COVID-19 pandemic, after accepting the opportunity to stay in an extended observation unit to optimize the chance for social work intervention, 70.7% of IPV survivors received a safe discharge—including 31% to a shelter—suggesting that increased coordination between hospital- and community-based systems have promise in meeting survivor needs ( 25 ). Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals.…”