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Emergency Department Protocol on Partner Abuse

Partner abuse of women results in a considerable number of deaths, injuries, long-term physical and mental consequences and considerable economic costs. Despite this, health care professionals have been slow to develop and utilise appropriate, proactive responses to the issue of abuse.

In 1993-94 the Alcohol & Public Health Research Unit collaborated with the Injury Prevention Research Centre, Faculty of Medicine & Health Services, in evaluating the development, implementation and outcomes of an emergency department protocol of care for the identification and treatment of women abused by their partners. This protocol was adapted from models developed overseas in collaboration with local emergency department staff and community group representatives.

While the Injury Prevention Research Centre focused on project coordination and outcomes, the Alcohol & Public Health Research Unit was responsible for formative and process evaluation. Formative evaluation was directed at ensuring that the programme was well-planned, soundly based, and responsive to emerging information about its feasibility, appropriateness and effectiveness. This involved consultative input from key stakeholders and information collected from emergency department staff, which was fed back to the project organisers. Process evaluation involved documenting and analysing the implementation of the programme.

Issues associated with the development of the protocol included the importance of ensuring that the guidelines developed were appropriate and safe for the women presenting to the emergency department, and appropriate for emergency department staff in terms of the time and physical constraints under which they worked. Input from staff and from the community was essential for ensuring the appropriateness and feasibility of the protocol.

Issues identified during implementation included the need for flexible delivery of the initial training. Staff responded positively, but reported initial difficulties in asking women about abuse and with the recommendation to conduct routine screening for abuse. When the protocol was modified to recommend assessment for abuse only when staff felt conditions warranted it, implementation went smoothly. Staff reported that the guidelines facilitated their response to the issue of abuse and reinforced the provision of good clinical care, and that the protocol had become well integrated into standard emergency department procedures.

Carla Spinola, Liz Stewart, Sue Laughlin, Janet Fanslow (IPRC)

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