‘Intimate Partner Violence and Emergency Department Screening: Computer Screening Versus Usual Care’ Annals of Emergency Medicine (2007) Vol 49, No. 4
Intimate Partner Violence (IPV): “any act of sex-based violence that results in physical, sexual, or psychological harm or suffering between current spouses, current nonmarital spouses, former marital partners, and former nonmarital partners”
Intimate partner violence appears not to respect race, class, colour or creed. Reports in the lay press, suggest that we might only be seeing the tip of an iceberg. The critical person in such circumstances is the victim. Getting such women to seek for help is however, not straight-forward. This is the important issue addressed by this study from the USA. The study was carried out in a large inner city Emergency Department in Baltimore USA, comparing the screening, detection and referral rates of patients suffering IPV. If we consider the UK setting, where women present to us as ’emergencies’ to the Delivery suite, Early Pregnancy Unit or on Acute Gynaecology take, they will by-pass the Emergency Department.
A comparison was made between those women who completed a computer based questionnaire, which included IPV questions along with others regarding social, health, personal issues; to women who were treated under the ‘usual’ care pattern which depended on medical staff asking the questions when they felt it was appropriate and then documenting this in the notes. The notes were then reviewed by a dedicated study team.
There were 4 specific questions, relating to past and current social relationships. Responses were self-entered on a laptop computer, placed in a private area in the triage/registration centre. The computer programme was web-based, so that more than one subject could be completing it simultaneously. Completion took 6 minutes on the average.
Results showed that using a computer based programme with IPV questions 100% of women were screened, with a 19% detection rate, compared to 30% who were screened via the ‘usual’ route with a 1% detection rate. Eligible women, who refused to participate, were older. Some 88% of the respondents reported that they liked answering questions using the method.
One thing that stood out was the exclusion criteria, as it effectively removed women at the real risk of IPV [e.g.: illiteracy, intoxication, the acutely ill and women who would not be separated from partner], therefore possibly introducing bias.
The significant point this paper highlights, albeit in a rather complex way, is that we may be missing a large proportion of women, who are at risk of domestic abuse in the acute setting. Specifically, this study suggests that a computer-based screening strategy may be an improvement over face-to-face screening, in the United States.
Back home, it is worthwhile to note that many super (store) counters, airline check-in counters and theory test centres for the DVLA now have easily accessible computer touch-screens. With the NHS Computer system around the corner, it might just be well to allow for a patient and a laptop in a private clinic area, and see how we can help.