From Warm Handoff to Wrap Around Care: Emergency Department Provider Perspectives

Background and Purpose:

Hospital emergency departments (EDs) are often first point of contact and care for many victims of intimate partner violence (IPV). And yet, the acute treatment of IPV symptoms in EDs is often ineffective in decreasing repeat victimization by IPV and improving victim engagement in services from partnering victim advocacy agencies. Effective mechanisms to bridge the gaps between the acute care provided in ED visits, the long-term care provided through victim’s advocacy agencies, and mandatory police reporting remain unknown. Digital interventions for DV have increased rates of referral and improved long-term outcomes for IPV in some outpatient clinics, and there is a critical need to explore the potential of these interventions to link ED patients to the long-term care provided by IPV victim advocacy agencies.

This study aims to understand provider perspectives on one such intervention, Domestic Violence Report and Referral (DVRR) through semi-structured interviews. Researchers solicited perspectives on perceived barriers and assets to use, including DVRR impact on patient care and provider workflow, and emergent themes related to the effective dissemination and application of DVRR were also considered.

Methods:

In-depth semi-structured interviews were conducted with 23 ED providers at two hospitals in northern California that use DVRR in patient care. Medical providers with experience using DVRR were invited to share their experiences administering DV care, and the impact of DVRR on that care, including procedural changes, barriers and assets to use, impact on both provider and ED workflow, and perceived impact on patient care and outcomes. Interviews were transcribed verbatim and analyzed using a combination of inductive and deductive codes with the assistance of Dedoose qualitative software.

Results:

Providers overwhelmingly identified the lack of space within the ED and the absence of appropriate resources to offer clients as the primary barriers in administering care to IPV victims.

Providers felt DVRR effectiveness increased when training in using DVRR was provided; however, many providers also felt that the structure of DVRR itself provided a training in administering DV resources and care they may have felt ill-prepared to administer, otherwise. The introduction of DVRR may have disseminated some of the burden of DV care previously placed on ED social workers to other providers; while this may increase the opportunities for patients to receive care, it may also make coordination and consistency of care difficult.

Conclusions and Implications:

Provider perspectives reveal the important role DVRR has played in ED responses to DV. Through streamlining care and providing a structured education and referral structure, DVRR empowers providers to administer more emotional support and DV education to patients and eases providers’ ability to connect patients to other supportive services. This will inform the future development of DVRR and similar interventions intended to facilitate supportive services access for DV-affected individuals. Future research may focus on patient perspectives on DVRR, including opportunities to improve patient experiences receiving this and similar interventions.