Universal screening for intimate partner violence in the emergency department: Importance of patient and provider factors

Study objective: Screening for intimate partner violence has been widely ad vocated in the health care setting, but efforts to assess effectiveness and ensure adequacy of universal screening are largely untested. We sought to identify barriers to screening of female emergency department patients for intimate partner violence during the first year of implementation of a scre ening protocol. Methods: A retrospective, structured medical chart review of 1,638 randomly identified visits included demographic factors of age, race, marital statu s, employment status, insurance status, arrival mode, mechanism of presenti ng complaint, severity of condition, presentation time, and nurse gender. T he study was conducted an an inner-city Level I trauma center with 43,000 a nnual ED visits and universal procedures for screening for intimate partner Violence in place since February 1994. The participants were a cohort of 1 ,509 female patients, 18 years of age or older, who were discharged from th e ED between July 1994 and June 1995. The main outcome measure was the odds of being screened as a function of patient and provider variables. Statist ical analyses involved univariate and multivariate logistic regression on s creening rates (Yes/No) as derived from universal screening instrument vari ables. Results: Of 1,638 records reviewed, 483 patients (29.5%) were screened for intimate partner violence. Univariate analyses revealed that women presenti ng with nonpsychiatric, less acute complaints and those who presented durin g daylight hours were more likely to be screened than women who presented w ith psychiatric or more acute complaints, or during the night shift. Male a nd female nurse providers were equally likely to screen for intimate partne r violence. Step-down multivariate analyses agreed with these findings. Conclusion: In this random sample of female patients, screening rates varie d by severity of the patient's condition, type of presenting complaint, and presentation time.