Development and validation of an emergency department screening and referral protocol for victims of domestic violence

Study objective: To describe the development, design, and validation of an emergency department protocol for the identification, documentation, and referral of victims of domestic violence. Methods: We based protocol development and design on a departmental needs assessment. The validation component involved the screening of women 16 years and older treated in the ED during a 2-week period at both triage (stage 1) and nursing assessment (stage 2). Sensitivity and specificity of the triage screen were determined. Results: The departmental needs assessment revealed several important limiting factors that motivated the design of the protocol. In response, the protocol design included a two-stage screening process, stage 1 taking place at triage and stage 2 as part of the nursing assessment. During the 2-week validation study, 595 women 16 years and older were treated in the ED, but complete two-stage screening data were obtained for only 114 (19%). Of the patients who were appropriately screened, eight screened positive at stage 1 and two of the eight were confirmed at stage 2. Two additional cases were identified at stage 2 in whom Violence had not been suspected at stage 1. Triage screen sensitivity was 50%, specificity 95%. Of the women properly screened at both stages, 3.5% were identified as victims of domestic violence. Conclusion: We identified many obstacles to implementation of an ED domestic violence screening and referral protocol, demonstrating that evaluation is imperative in determining actual clinical impact.