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Sample Policy 3: Hospital Emergency Room Policy

The Hospital Emergency Department conducts routine universal screening for domestic violence. When it is a case of intimate partner abuse, the patient is referred to the Partner Abuse Sexual Assault Care Team.

Universal Screening:

• To document reason for Emergency Department visit.
• To recognize and refer to appropriate resources.
• Because most victims of domestic violence who present to hospitals report that if asked, they would be prepared to discuss their history of abuse.
• Because earlier intervention is likely to increase the probability of stopping the violence before it escalates to more serious harm.

Indicators of Partner Abuse:

• Delay in coming in for treatment;
• Injuries not consistent with story;
• Overbearing partner;
• Partner answering for patient or controlling visit, and insisting patient not be seen alone;
• Repeat ER visits with physical complaints;
• Lacking physical etiology after investigation;
• Demonstrated fear of partner, worrying about timelines in relation to partner;
• Child abuse – children in ER; and
• Poor medical care (e.g., old injuries).

Procedure:

• I. The triage nurse shall ask all individuals about abuse/violence in routine assessment/treatment. The following question is an example:
  • I.1. “It is our duty to be patient advocates and screen for abuse. We know that many individuals experience problems in relationships, which can result in health problems. Are you in a relationship with someone who threatens to or has hurt you in any way?”
• II. It is not necessary to ask the above question verbatim providing that the central screening message is clear.
• III. If the triage nurse is unable to complete this task s(he) will ensure that the patient is screened before leaving the emergency department.
• IV. The nurse shall:
  • IV.1. Interview the patient alone;
  • IV.2. Convey that the patient is believed; and
  • IV.3. Convey an attitude of concern, respect and confidentiality.
• V. If abuse is strongly suspected ask: “I’m concerned about how you got these injuries. Did someone do this to you?” or “We often see injuries/symptoms like yours when a patient has been hurt by a spouse/partner. Is this happening to you?”
  • Offer the Partner Abuse Sexual Assault Care Team (PASACT)
• VI. If patient refuses the PASACT:
  • VI.1. Let the patient know that abuse is a crime that she/he is not alone and it is not her/his fault
  • VI.2. Assess immediate safety of the patient and develop safety plan – use OPP handout (can be obtained from local OPP department);
  • VI.3. Provide patient with list of community resources; and
  • VI.4. Document information on patient’s chart and complete the Domestic Violence screening form with the patient’s consent.

 

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Source: Cornwall Community Hospital (2000). Partner Abuse Sexual Assault Care Team Policy and Procedure Manual. Cornwall, Ontario. Reprinted with permission.

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