Increasing emergency physician recognition of domestic violence

To determine whether recognition of domestic violence in the emergency department is affected by restructuring of the ED chart to include a specific question about domestic violence, to evaluate whether training concerning domestic violence further increases its recognition, and to develop a profile of women who present to the ED as a result of domestic violence.

We collected prospective data on all females aged 15 to 70 years who presented to an urban Level I trauma center during a 3-month period. Two keywords were used to define domestic violence: (1) mechanism (eg, kicked, hit, pushed) and (2) perpetrator (eg, current/former boyfriend, spouse). We used the first month to define the baseline number of domestic violence cases. We modified charts in the second and third months (intervention months) to include, "Is the patient a victim of domestic violence?" In addition, the third month included a 1-hour educational lecture on the identification of domestic violence in the ED.

We identified 123 cases of domestic violence from a survey population of 4,073: 25 (2.0%) in the baseline month, 49 (3.4%) in the chart-modification month, and 49 (3.6%) in the education month. The proportion of cases identified during the intervention months was 1.8 times higher than during the control month (relative risk [RR], 1.78; 95% confidence interval [CI], 1.15 to 2.75), but did not differ between each other (RR, 1.06; 95% CI, .72 to 1.57). Women identified as domestic violence cases ranged in age from 15 to 61 years (median, 28.5 years). Most of the identified domestic violence patients presented with a triage classification of assault (54.5%), trauma (8.1%), or abdominal complaints (7.3%). Triage complaint differed for domestic violence and non-domestic violence cases (chi 2 = 830; P < .0001). Nearly one third of domestic violence patients (31.7%) presented between 11 PM and 6:59 AM, compared with 19.0% of non-domestic violence patients (chi 2 = 12.4; P = .005).

Modification of the chart significantly increased the recognition rate of domestic violence. An education intervention did not significantly improve this rate. The profile of a woman presenting to the ED differs from those of other women with respect to chief complaint and time of presentation.