Elizabeth A. Edwardsen

Family perspective of medical care and grief support after field termination by emergency medical services personnel: a preliminary report.

Objective. To determine the acceptance by family members regarding nontransport of patients in cardiac arrest following unsuccessful resuscitation occurring in private residences. Methods. This was a survey with a structured telephone interview. Inclusion criteria included adult patients in asystolic nontraumatic cardiac arrest. The setting was an urban multitiered emergency medical services (EMS) system. Termination of field resuscitation efforts was authorized by an emergency medicine physician at a medical control base station after set protocol criteria. Support services were provided by trained personnel. Results. Thirty-three follow-up interviews were completed with a family member. Thirty-two (97%) of the contacted family members expressed satisfaction with the services provided by EMS personnel. Twenty-one (64%) patients were not transported to the hospital. All 21 family members of the nontransported were satisfied with both the medical care and the emotional support provided by EMS. Additionally, family members of three of the 12 (25%) transported patients stated they would have preferred to have the patient die at home instead of being transported. Conclusions. In this small sample, family members accept the nontransport of patients by trained EMS personnel after asystolic nontraumatic cardiac arrest occurring in private residences. This may positively impact emergency department resources for other critically ill patients.

Intimate Partner Violence Resource Materials Assessment of Information Distribution

Objective: To determine the educational impact of placing partner violence resource information in a medical setting. Method: A cross-sectional study with a structured interview. Setting: Emergency department (ED) in an urban academic medical center. Participants: adult patients and visitors. Interventions: Educational materials and community resource information. Results: 51 patients and 71 visitors (N = 122) met the inclusion criteria and consented to enrollment during a 2-week study period. Of the participants, 71% were female and 29% were male. Sixty-five (53%) of the participants noticed the literature or cards. Ten (8%) read the materials. Seven (6%) retained a copy of the literature. Nineteen (16%) of the participants acknowledged knowing someone who could benefit from the information. Nine (7%) revealed that some of the information was new to them. Conclusions: Placing intimate partner violence resource pamphlets and cards in a medical setting is one means of educating the community and promoting violence prevention.

Structured practice opportunities with a mnemonic affect medical student interviewing skills for intimate partner violence.

Background: Low rates of partner violence inquiry and detection are reported in the medical setting. Purpose: To determine if a teaching module with a mnemonic improves interviewing skills. Method: Prospective randomized trial. A total of 43 medical students were assigned to either the intervention group (teaching module with guided discussion and practice highlighting use of a mnemonic) or the control group (general discussion and provision of the mnemonic at the end of the session). These students subsequently interviewed simulated patients. Results: A total of 75% of the intervention group and 62% of the control group reported the mnemonic was helpful. A total of 68% of the intervention group and 45% of the control group asked a direct question about partner violence. Students who obtained a history of abuse consistently asked direct, nonjudgmental question(s). Conclusions: Students learn to perform desired interviewing skills more frequently when they have the benefit of guided discussion, practice, and memory aids.

Protection Order Petitioners’ Health Care Utilization

Little work has explored the extent to which female victims of intimate partner violence use medical and legal services. In this cross-sectional study of a sample of women seeking orders of protection at family court (N = 95), we report descriptive, self-report data on health care utilization and insurance coverage. Although 85% of the petitioners had private or public health insurance, 39% reported delayed medical care, and 14% had not obtained medical care of any kind. The response to address interpersonal violence victimization should attempt to connect women using the courts with needed health care services.

Improving identification and management of partner violence: examining the process of academic detailing: a qualitative study

BackgroundMany physicians do not routinely inquire about intimate partner violence.PurposeThis qualitative study explores the process of academic detailing as an intervention to change physician behavior with regard to intimate partner violence (IPV) identification and documentation.MethodA non-physician academic detailer provided a seven-session modular curriculum over a two-and-a-half month period. The detailer noted written details of each training session. Audiotapes of training sessions and semi-structured exit interviews with each physician were recorded and transcribed. Transcriptions were qualitatively and thematically coded and analyzed using Atlas ti®.ResultsAll three study physicians reported increased clarity with regard to the scope of their responsibility to their patients experiencing IPV. They also reported increased levels of comfort in the effective identification and appropriate documentation of IPV and the provision of ongoing support to the patient, including referrals to specialized community services.ConclusionAcademic detailing, if presented by a supportive and knowledgeable academic detailer, shows promise to improve physician attitudes and practices with regards to patients in violent relationships.

Improving Coordinated Responses for Victims of Intimate Partner Violence: Law Enforcement Compliance With State-Mandated Intimate Partner Violence Documentation

New York State law mandates specific intimate partner violence (IPV) documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n = 191), more often when injury occurred (p < .01) and the defendant had prior court contact (p < .05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation.