Identifying Domestic Violence (DV) and sexual assault (SA) presentations and referral pathways at John Hunter Hospital Emergency Department: comparative analysis of DV and SA cases

Abstract Background: There are a number of negative and often long-term mental and physical health consequences of Domestic violence (DV) and Sexual assault (SA). Women experiencing DV and SA visit their health care professional more frequently than women not experiencing these abuses. Health care professionals in any health care settings can play crucial roles in identifying, managing and preventing DV and SA. In particular, those who work in emergency departments (EDs) are in a unique position to identify patients and initiate early interventions as they are often the first point of contact to access help. Methods: This is a retrospective observational cross-sectional study. Data was extracted from the site ED electronic information system (ipm) for all eligible females (alleged assault) who presented within the study period. Statistical analyses were programmed using SAS v9.4 (SAS Institute, Cary, North Carolina, USA). All data were checked for completeness and discrepancies before analysis. Descriptive statistics are reported for all relevant variables. The Hosmer-Lemeshow goodness of fit test was used to determine the adequacy of fit between the final model and the data. Results: Study findings indicate the high level of mental health issues among women presenting with both DV and SA. More than half of the victims had recurrent presentations to ED. The majority of victims were referred to the related support services within hospital or external services. Most of injuries in the sample were sever physical injuries. Conclusions: As the first point of contact, ED health professionals have a crucial role to identify and respond to SA and DV cases. If identified early, the recurrent admissions can be prevented and any early intervention can have a positive benefit for the longer-term health of the DV and SA victims. It can also save health care system spending. The development of a DV/SA flowchart for identification of these cases in ED as well as a clear referral pathway and ideally mandatory DV routine screening at EDs in all hospitals would be some practical strategies for achieving early intervention. Keywords: Domestic Violence, Sexual assault, Emergency Department, Domestic Violence screening, recurrent presentations