Janet M Williams

Comparison of domestic violence screening methods: a pilot study.

STUDY OBJECTIVE Previous studies have indicated a number of barriers to screening for domestic violence (DV) in an emergency department setting. These barriers result in inconsistencies which determine who is screened as well as the content and quality of the information obtained, and if uncontrolled they are likely to affect measurements of DV incidence in ED populations. The objectives of this project were to design a screening tool that circumvented these barriers and sources of error; to assess whether such an alternative method of screening for DV was acceptable to our patients; and to determine whether the alternative and traditional methods of screening for DV would yield comparable results. Our hypotheses were that the alternative screening tool would be acceptable to our patients and that no significant differences would be found between the two methods. METHODS The study took place in a rural, university-affiliated ED with approximately 36,000 annual patient visits. The study population consisted of 186 women older than 18 years of age who were treated by one designated physician. Approximately half of these subjects were screened for DV in a face-to-face interview. The other half listened to a tape-recorded questionnaire and recorded their responses on a coded answer sheet. RESULTS There were 175 completed screenings. The average age of all respondents was 34 years, and 90 (51%) indicated a cumulative lifetime experience of DV of some sort. Overall, 3% of the respondents indicated they were in the ED for injuries received as a result of DV. No significant differences were found between the two methods of screening for DV on any measurement, including refusals. No problems hearing the tape or understanding the instructions were reported. CONCLUSION These results indicate that the alternative method of employing a recorded questionnaire was no less effective than the best efforts of a designated and conscientious physician. As a means of quickly assessing the prevalence of DV in an ED setting, we find much to recommend such an approach.

Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department.

Abstract The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

Injury Recidivism in a Rural ED

STUDY OBJECTIVE To determine the degree of injury recidivism in our ED population and to identify indicators of injury recidivism. METHODS We conducted a retrospective review in a university-affiliated department of emergency medicine. The study participants were patients who presented for treatment of an injury. An injury recidivist was defined as a patient who presented for treatment of two or more unique injuries during the 1-year study period. The injured population was divided into three categories: (1) those with a single injury visit, (2) those with two to three injury visits, and (3) those with four or more injury visits. Demographics, mechanism of injury, and outcome data were collected and comparative analyses performed. RESULTS Of the 37,360 ED patient visits, 12,075 were injury related. Of the injury visit load, 2,838 of the 12,075 (24%) were injury recidivists. Of injured patients, 1,239 of 10,476 (12%) were recidivists. The sex distribution was similar among the groups, but the mean age decreased as the degree of recidivism increased. The degree of recidivism was higher for patients with Medicaid and for those who were uninsured. Lower mean medical charges per visit were found with increasing degree of recidivism, but the average total charges per patient increased with increasing degree of recidivism. Increasing degree of recidivism was associated with decreasing incidence of transportation-related injury but increased incidence of overexertion or intentional injuries. CONCLUSION A small group of patients account for a significant proportion of ED injury visits. In comparison with injury patients seen once during the year, recidivists represent a younger population of lower socioeconomic status, and they are at increased risk of intentional injury.

The Emergency Department Log as a Simple Injury-Surveillance Tool

STUDY OBJECTIVE To describe the development of an injury-surveillance system based on the emergency department log. SETTING An ED with 40,000 visits annually, tertiary care center. PARTICIPANTS All patients to our ED during a 6-month period. ED logs are used to collect basic information such as demographics, chief complaint, mode of arrival, and disposition. Our log was modified for collection of injury-related information such as whether the ED visit was because of an injury and, if so, the mechanism of injury. A list of 16 mechanism-of-injury codes was developed on the basis of review of existing literature and on a 1-month review of injuries in our population. The ED log data were entered into a database, and descriptive analysis was performed. RESULTS A list of mechanisms of injury was developed that, when implemented, was successful in coding 93% of injured patients in our ED population. The expansion of the ED log for collection of injury data required minimal training and cost. An example of the data obtained is presented to demonstrate the type of information available. Of the 18,742 patients, the ED log identified 5,067 patients (27%) as having been injured. Most were male (2,972 of 5,067 [59%]), and most were between 15 and 40 years of age (2,857 of 5,067 [61%]). Common mechanisms of injury included falls (907 of 5,067 [19%]), transportation (706 of 5,067 [15%]), cuts or punctures (332 of 5,067 [7%]), sports (323 of 5,067 [7%]), and assaults (245 of 5,067 [5%]). CONCLUSION With minimal training and cost, the ED log can be adapted for collection of injury data on all patients seen in the ED.

Development of an Emergency Department—Based Injury Surveillance System

STUDY OBJECTIVE To describe the development of an emergency department-based injury surveillance system, to describe the problems encountered, and to briefly describe the data output and potential applications. METHODS Within our university-based hospital system and Level I trauma center register, injury data currently exist on all ED patients. Over a 1-year period, these data sets were linked with our ED log using the hospital identification number and date of service as the key merge variables. Elements in our data set included demographic information, ED-related variables, and codes for nature of injury and circumstances of injury. Data files for 1 month were inspected manually to validate the success of the merger. Problems encountered in developing the system were summarized. RESULTS A manual review of 1 month of data files from our hospital system, trauma register, and ED log revealed that the records of more than 97% (2,802) of 2,878 injury patients seen in our ED had additional data attached after the merger. No errors of commission were found, but errors of omission occurred. The barriers that were encountered during the development of this injury surveillance system are described. CONCLUSION Hospital data can be linked to the ED log to create an injury surveillance system that captures valuable information on patients admitted and discharged from the ED.