Intimate partner violence screening and response in New South Wales emergency departments: A multi-site feasibility study
2020 Australasian College for Emergency Medicine Objective: To test feasibility of a systematic approach to routine screening and response for intimate partner violence among women presenting to three New South Wales EDs. Methods: This prospective feasibility study was conducted over 6 months in two rural and one major tertiary metropolitan ED in New South Wales. Women aged 16-45 years triaged category 3-5 (treat within 30 min/1 h/2 h), who could be approached privately, were screened for intimate partner violence using the validated HITS (Hurts, Insults, Threatens and Screams or Swears) tool. The follow-up protocol for patients who disclosed abuse, specified a social work/psychology (psychosocial) response within 1 h. Outcomes of interest were screening rates of eligible presentations, disclosures of abuse, psycho-social referral and responses. Interviews conducted with ED medical directors and nurse unit managers at each site explored barriers and facilitators. Results: A total of 1047 women (11.4% of eligible presentations) completed screening at their first or subsequent presentation. Of 868 women screened on first presentation, 18% (n = 154) disclosed intimate partner violence, with no significant differences by age group, country of birth, triage category or time/day of arrival. Key barriers to screening were high patient volume, absence of electronic prompts and lack of privacy. Of those who screened positive 49% (n = 75) received an immediate, on-site psycho-social response. Conclusion: The present study demonstrates that it is both possible and relevant, given the 18% disclosure rate, to screen women in relation intimate partner violence in EDs and provide a psycho-social response within 1 h. More needs to be done to address barriers to screening to provide opportunities for early intervention.