The impact of a sexual assault/domestic violence program on ED care

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.

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.

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).

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.