Critical call for hospital-based domestic violence intervention: The Davis challenge

Background: 50% of women killed in intimate partner violence (IPV) were seen by a health care provider within a year of their death. As guest speaker to Virginia Commonwealth University Trauma Center (VCU-TC), Dr. James Davis (Western Trauma Association - past president) challenged VCU-TC to develop a hospital-based IPV program. This research examines the development and impact of an integrated hospital/VCU-TC based IPV program. Methods: IPV survey was carried out to determine need for training and screening. Hospital forensic nurse examiners (FNE) case logs were evaluated to determine IPV prevalence. An integrated IPV program - Project Empower was developed, consisting of staff education, patient screening, victim crisis fund, and interdisciplinary sexual assault/domestic violence intervention team. Between 2014-2018, patients admitted with an IPV consult to Project Empower were entered into a secure database capturing demographics, mechanisms, income data, and social determinants of risk. Program feasibility was evaluated on patient engagement via screening and case management. Program impact was evaluated on crisis intervention, safety planning, and community referral. Results: FNE data and IPV survey evaluation noted 20% IPV prevalence and lack of IPV screening and training. IPV patients (N=799) were women (90%), unmarried (79%) and African-American (60%). Primary mechanisms were firearm (44%) or stabbing (34%). Survivors were perpetrated by a cohabiting (42%) or dating partner (18%). Monthly income averaged $622. 40% had no health insurance. Advocates provided 62% case management. Survivors received victim crisis funds (16%), safety planning (68%), crisis intervention (78%), sexual and domestic violence education (83%), and community referral (83%). Within five years, 35 (4 %) were re-injured and seen in the ED. 31 (4%) were readmitted for IPV related injuries. Two deaths were attributed to IPV. Conclusion: Critical call for hospital-based IPV intervention programs as a priority for trauma centers to adopt cannot be underestimated but can be answered in a comprehensive integrated model. LEVEL OF EVIDENCE: III STUDY TYPE: Original Article, Therapeutic.