Screening for intimate partner violence in the emergency department: Perceptions and barriers

Background and Objectives: Intimate Partner Violence (IPV) is a public health crisis associated with significant morbidity and mortality. Emergency Departments (ED) see a disproportionately high number of victims of IPV; organizations such as the Joint Commission have defined standards for identifying victims of IPV in the ED. However, screening often fails and there is little data on what limits our ability to screen for IPV in the ED. With the recent COVID-19 pandemic, incidence of IPV has increased and intensified the need to identify these patients and provide adequate resources. Often, screening falls to trained nurses and advanced practice providers (APP) in triage or as part of bedside nursing assessment. Our objective was to understand the barriers to screening as perceived by those responsible for screening our ED patients. Method(s): 106 ED nurses and APPs who perform IVP screening were surveyed anonymously utilizing Survey Monkey tm about their ability to screen for IPV, perceived barriers to screening, and their actual vs ideal practices of IPV screening. The 30-question survey was developed utilizing semi-qualitative methodology, including an iterative process involving interviews and question revision. A sub-sample was interviewed after the final iteration to ensure content and face validity. Responses were collected via email and QR codes posted in the ED. Result(s): Our response rate to date is approximately 71%. Only 43% of respondents recalled receiving any IPV training and only 35% of respondents felt the training they received was helpful to their practice. Participants estimated 31% of women and 19% of men have experienced IPV and that recent shelter in place policies have likely increased the rates of IPV. However, only 34% of respondents felt that ED triage was the appropriate place to screen. The top three reasons given were a lack of patient privacy, feeling uncomfortable with the topic, and that screening for IPV is not relevant to the patient's visit. The majority of respondents feel comfortable performing next steps after a positive screen. Conclusion(s): This important public health epidemic has the potential to be identified in the ED. Research is needed to understand where the process fails both providers and patients. This study recognizes the importance of the provider perspective in failing to screen patients for IPV. Research is needed to further clarify these barriers and identify ways of overcoming them.