ResearchThe Impact of a Sexual Assault/Domestic Violence Program on ED Care
Section snippets
Overview
We retrospectively examined charted characteristics of sexual assault patients presenting to academic emergency departments in Kingston before (January 2001 to August 2004) and after (August 2004 to August 2006) implementation of the SADVP. The cohort of patients in the pre-SADVP time frame was chosen to maximize the number of patients seen for comparison purposes by use of the most current version of the ED chart, introduced in January 2001.
Setting
Kingston is a city in Eastern Ontario, Canada, with a
Patient and Assault Characteristics
We identified 61 patients reporting sexual assault in the pre-SADVP phase (approximately 1 per month) compared with 92 patients in the post-SADVP phase (approximately 2 per month). All 92 patients in the post-SADVP phase were women, whereas 3 of 61 patients (5%) in the pre-SADVP phase were men. Patient characteristics are further described in Table 1. No significant differences were observed between the patient groups in terms of age, relationship with assailants, number of assailants, weapon
Discussion
The introduction of the SADVP in Kingston resulted in improvements in key areas of clinical care. Pregnancy and STD prophylaxis was given almost universally in the post-SADVP group, which improved upon the high standard of care seen in the pre-SADVP group. The US national averages for provision of STD prophylaxis and pregnancy prophylaxis range from 29.6% to 60% and 7.4% to 20%, respectively.12, 13 The baseline provision of both STD and pregnancy prophylaxes before the introduction of the SADVP
Limitations
One limitation in the pre-SADVP arm of our study is the reliance on presenting complaint and discharge diagnosis for the identification of sexually assaulted patients, which may not be documented and coded, respectively, for their ED stay. In an attempt to reduce the impact of this potential area of error, additional charts were identified by use of the broader search term of “assault.” Abstraction of time to patient contact from the medical record has its limitations, including human error
Implications for Emergency Nurses
This study shows that a primarily nursing-based adjunct ED program improves the quality of care provided to victims of sexual assault. It initially appears counterintuitive that wait times would be decreased in a call-in based service, but rather, the decrease seen in the SADVP on-call group reflects the reality that ED overcrowding and bed blocking are the rate-limiting steps in the initiation of assessment and treatment of patients. Forensic sexual assault examinations are lengthy in nature,
Conclusions
After the introduction of the SADVP, more patients were seen with a shift to include less stereotypical sexual assaults. Decreased wait times were observed for sexually assaulted patients, despite the need for the on-call nurses to attend the emergency department. ED flow is improved through the use of dedicated nursing staff and examination facilities. This program also showed higher completion for a number of important indicators of quality of care, including provision of pregnancy and STD
Kari Sampsel, Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada.
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Cited by (23)
Acute concomitant injury and intoxication in complainants of recent sexual assault: A review
2022, Journal of Forensic and Legal MedicineCitation Excerpt :Severity definitions are described in Table 2. Of the studies commenting on injury severity, most cases were noted as ‘mild’ in severity,15,42,46–48,50–52,67 consistent with previous reviews,6,11 and earlier studies of injury in sexual assault complainants.10,11,66,68,69 ‘Moderate-to-severe’ extra-genital injury, particularly injury requiring medical/surgical intervention and/or hospitalisation, however, may not be as uncommon as previously understood.6,11,12
Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada
2018, Nurse Education TodayCitation Excerpt :In North America, these programs are frequently staffed by specially trained on-call forensic nurse examiners, who provide a comprehensive range of services that include crisis support, physical examination, documentation of injuries, provision of prophylactic medication for the prevention of pregnancy and sexually transmitted infections (including HIV), forensic evidence collection, referral to on-site follow-up medical care and counselling, and community agencies for ongoing support (Campbell et al., 2005; Du Mont and Parnis, 2002). The implementation of such programs has been shown by Sampsel et al. (2009) to reduce wait time for initial clinical evaluation from 30 min to 22 min and increase time devoted to medical examination among individuals requiring acute sexual assault care, administration of sexual assault evidence kits (also known as rape kits), and use of acute care services such as pregnancy and sexually transmitted infection prophylaxis. Such programs have been shown to provide more rigorous collection and storage of forensic evidence which can improve prosecutorial outcomes (Campbell et al., 2012; Sievers et al., 2003).
A Meta-Analysis of HIV Postexposure Prophylaxis Among Sexually Assaulted Patients in the United States
2018, Journal of the Association of Nurses in AIDS CareCitation Excerpt :Of the six studies examining n-PEP being offered to SA patients, five studies stated whether or not a forensic nurse or SANE participated in the patients' care. Historically, several aspects of health care delivery will improve when SANE or forensic nurses are involved (Bechtel et al., 2008; Campbell, Patterson, & Lichty, 2005; Campbell et al., 2014; Sampsel, Szobota, Joyce, Graham, & Pickett, 2009); however, our results did not consistently bear this out. The lone study that did not note the availability of a SANE had the lowest rate of n-PEP (19%), which was similar to Draughon and colleagues (2015), in which all patients were treated by a forensic nurse, yet one of the sites had a 22% n-PEP rate.
Is there a role for paediatric Sexual Assault Nurse Examiners in the management of child sexual assault in Australia?
2016, Child Abuse and NeglectCitation Excerpt :The HTA report found evidence to support improved health and legal outcomes for patients treated by a SANE including: documented genitourinary examinations, documented genitourinary injury, testing and treatment for STIs, pregnancy testing, prophylaxis for pregnancy, referral to rape crisis centres and counselling services, assault reported to, and filed by, police, evidence kits completed, higher conviction rate and longer average sentence. The 4 pre and post intervention studies report evidence for better judicial outcomes in adult (Campbell et al., 2014) and child victims (Patterson & Campbell, 2009); improved clinical care (Hornor et al., 2012; Sampsel et al., 2009); improved emotional care (Sampsel et al., 2009); and improved accessibility for child victims (Hornor et al., 2012) and adult victims (Sampsel et al., 2009). Despite the lack of evidence describing models of care and elements of best practice, most studies describe nurse-led programs based in the Emergency Departments of hospitals that work in collaboration with multidisciplinary Sexual Assault Response Teams (SARTs) to provide a high standard of medical and forensic care to victims of SA (Cole & Logan, 2008; Esteves et al., 2014; Goyal et al., 2013; Logan, Cole, & Capillo, 2007).
Low-fidelity hybrid sexual assault simulation training's effect on the comfort and competency of resident physicians
2015, Journal of Emergency MedicineCitation Excerpt :The development and expansion of these programs has been credited with higher sexual assault case conviction rates, longer sentences, and increased prosecution rates (3,14). They have also been shown to decrease wait times for victims and meet higher markers of quality care (1,5,6,17). This paradigm shift away from physicians to SANEs has improved the quality of care of victims, but has some unintended consequences.
Kari Sampsel, Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada.
Luke Szobota, School of Medicine, Queen’s University, Kingston, Ontario, Canada.
Donna Joyce, Manager, Sexual Assault Domestic Violence Program, Queen’s University, Kingston, Ontario, Canada.
Karen Graham, Assistant Professor, Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada.
William Pickett, Associate Professor, Departments of Emergency Medicine and Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada.
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