A rich data set on victims of domestic violence who presented to VCH Emergency Departments – information that is a legacy from VGH and St Paul’s Hospital unique domestic violence program – has provided the opportunity for a VCH Research study on repeat presenters. The study examined the differences between those who came to the ED for one visit versus those who presented two or more times. Led by Kathleen Mackay, clinical social worker with the VCH Suicide Attempt Follow-up, Education & Research (S.A.F.E.R.) Program, the study found that among the factors investigated, the most robust predictors of multiple visits to the ED as a result of domestic violence are:
- Ethnicity, with aboriginals being most at risk
- Previous abuse by a different perpetrator
- Having received threats of death from the abuser
- Mental illness being the patient’s primary/main presenting complaint
Some of the implications of repeat visits include being more likely to have received threats to kill or have family threatened, statistically significantly longer stays in the ED, and in terms of triage acuity, significantly more likely to be classified as urgent vs. semi-urgent or non-urgent.
This VCH research study was made possible as a result of data collected from patients at VGH and St Paul’s Hospital between 1997 and 2009. While VCH protocols support universal screening for the presence of domestic abuse of all patients who present to clinical settings at VCH, this is not always possible. From the study’s findings, the team recommends the creation of a clinical guidelines tool that will better ensure patients presenting to the ED with the above predictors be screened for the possibility of domestic violence. This will help improve rates of screening for high risk patients as identified in the data.
Through screening, patients are provided with better quality of care – they are directed to a social worker who will ensure a complete record of their abuse is taken, and they will also be referred to services in the community, including temporary shelter if they are unable to go home. Police may also get involved if agreed to by the patient.
Kathleen Mackay and her team were recipients of the 2008 VCH Research Team Grant, which helped fund this study. Other team members include Dr. Patricia Janssen, researcher and professor with UBC School of Population and Public Health, Dr. Riyad Abu-Laban, physician and VGH research director, VGH Department of Emergency Medicine, and Jennifer Petty, RN and clinical analyst, Core Acute Information System, IMIS, VCH.
The team hopes to be able to use the Domestic Violence Program data set, which is considered one of the most comprehensive in the world, for future studies on domestic violence.
The study, Prediction of Repeat Visits by Victims of Intimate Partner Violence to a Level III Trauma Centre, was published in the journal ISRN Emergency Medicine September 30, 2012.