An evaluation of a system-change training model to improve emergency department response to battered women

Objectives: To evaluate a system-change model of training from the Family V iolence Prevention Fund and the Pennsylvania Coalition Against Domestic Vio lence for improving the effectiveness of emergency department (ED) response to intimate partner violence (IPV). Methods: An experimental design with o utcomes measured at baseline, 9-12, and 18-24 months post-intervention. Twe lve hospitals in Pennsylvania and California with 20,000-40,000 annual ED v isits were randomly selected and randomly assigned to experimental and cont rol conditions. Emergency department teams (physician, nurse, social worker ) from each experimental hospital and a local domestic violence advocate pa rticipated in a two-day didactic information and team planning intervention . Results: The experimental hospitals were significantly higher than the co ntrol hospitals on a staff knowledge and attitude measure (F = 5.57, p = 0. 019), on all components of the "culture of the ED" system-change indicator (F = 5.72, p = 0.04), and in patient satisfaction (F = 15.43, p < 0.001) af ter the intervention. There was no significant difference in the identifica tion rates of battered women (F = 0.411, p = 0.52) (although the linear com parison was in the expected direction) in the medical records of the experi mental and control hospitals. Conclusions: A system-change model of IPV ED training was effective in improving staff attitudes and knowledge about bat tered women and in protocols and staff training, as well as patient informa tion and satisfaction. However, change in actual clinical practice was more difficult to achieve and may be influenced by institutional policy.