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A lethality assessment program in the emergency department: Program implementation and evaluation

Howard C, Silva SG, Waldrop J, Stone E, Schafer BP, Gonzalez-Guarda RM
J Emerg Nurs

INTRODUCTION: Despite routine screening for intimate partner violence and validated screening tools for lethality, intimate partner violence assessment and linkage to services remain inconsistent in health care settings. This program aimed to implement and evaluate a lethality assessment program, a nurse-led screening and prevention program for intimate partner violence homicide in an emergency department that partnered with a local community agency. 

METHODS: A single group pre-post design was used to evaluate changes in knowledge of intimate partner violence and the lethality assessment program protocol and confidence in implementing the protocol among 143 registered nurses in the emergency department. Program outcomes were assessed during a 4-month post-implementation period. Focus group interviews were conducted and analyzed to identify barriers and facilitators of implementation. 

RESULTS: Significant improvements in the nurses' knowledge and confidence in implementing the protocol (all P< .001) were observed. Fourteen lethality screens were completed during the 4 months, with 13 indicating high intimate partner violence homicide danger. Eight victims received 20 services (1-5/person) from the local community organization: emergency shelter, safety planning, legal aid, and domestic violence protection order. Barriers to implementation included time, privacy, training, and access to screening forms. Facilitators included champions, resources to allow for implementation, and prompts. 

DISCUSSION: The lethality assessment program is a feasible protocol in a health care setting to increase intimate partner violence awareness, link high-risk intimate partner violence victims to needed services in real time, and potentially reduce intimate partner violence homicides. Programs like this are essential to address this public health concern.

Howard C, Silva SG, Waldrop J, Stone E, Schafer BP, Gonzalez-Guarda RM. A lethality assessment program in the emergency department: program implementation and evaluation. J Emerg Nurs. 2024. Epub ahead of print. DOI:10.1016/j.jen.2024.09.004. PMID: 39365193

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Process
Social Needs/ SDH
Provider Experience of Care
Population
Health Care Professionals
Screening research
Yes
Social Determinant of Health
Violence/Safety
Study design
Pre-post without Comparison Group
Keywords