Missed opportunities: Emergency department visits by police identified victims of intimate partner violence

Study objective: We examine all emergency department (ED) utilization by police-identified women victims of intimate partner violence as part of an intimate partner violence ED surveillance study to determine the frequency and characteristics of visits and the extent of intimate partner violence screening and identification by ED staff. Methods: We conducted a retrospective observational case series reviewing countywide EDs visits, 1999 to 2001, for women victims in the 2000 prosecutor's intimate partner violence database. Stratifying visits by whether the woman presented with an injury, we assessed documentation of intimate partner violence screening and identification and mental health and substance abuse in the medical records. Results: Of 964 female intimate partner violence victims in the 2000 prosecutor's intimate partner violence database, 616 (63.9%) received care in at least 1 ED in the year of the index assault. During the 3-year study period, 788 (81.7%) victims generated a total of 4,456 ED visits. Intimate partner violence screening was documented in 1,349 (30.3%) of the 4,456 visits but resulted in only 259 (5.8%) positive screens. However, because they use the ED so frequently, 23.0% of individual intimate partner violence victims were eventually identified. The median number of visits for victim ED users was 4 (range 1 to 71), and visits were just as likely to occur before the known intimate partner violence incident as after, although ED visits tended to peak in the month of the incident. Injury-related visits were 50% more likely to have documented IPV screening, however, most visits (71.2%) by IPV victims were for noninjury-related complaints. Conclusion: Police-identified intimate partner violence victims utilize emergency care at extremely high rates, usually without identification or referral to intimate partner violence resources.