Emergency departments and abuse: policy issues, practice barriers, and recommendations

The abuse of women has reached epidemic proportions. There are an estimated 12 million abused women in the United States. Reported cases of abuse, however, range from 2 to 4 million. Less than 15% of these women ever seek medical care. Of women who do seek care, an estimated 75% use the emergency department, often presenting with complaints not readily suggestive of abuse. Reports indicate, however, that emergency departments consistently identify less than 10% of all abuse cases. In 1991 and 1992, the Joint Commission on Accreditation of Healthcare Organizations established standards for emergency departments to develop policies and procedures for the identification, treatment, and referral of female and elderly victims of abuse. Virtually all emergency medicine professional societies have official policies to encourage development of protocols for abuse identification and management. The American Medical Association and the Department of Health and Human Services have likewise developed guidelines to help emergency departments achieve these national health care objectives. Currently, less than 50% of all emergency departments have established algorithms to address abused women who present to the emergency department for treatment. This article reviews current health policy, examines the impediments to the detection of abuse in the emergency department, and recommends mechanisms to enhance the awareness of abuse among emergency department personnel.