374 Knowledge, Attitudes, and Behaviors Regarding Care of Sexual Assault Survivors in the Emergency Department

Abstract

Sexual assault (SA) survivors may qualify for state-mandated specialized forensic care, which requires extensive time and expertise. Few studies have looked at provider experience. We examined the knowledge, attitudes, and behaviors of providers of forensic care in a high-volume, urban emergency department (ED) serving SA patients aged 12 years or older. Providers are defined as either sexual assault forensic examiners (SAFEs) or emergency medicine faculty (EMF) who typically perform forensic care when no SAFE is available. SAFEs are individuals who have completed either a 40-hour course or an 8-hour advanced practitioner course and take call. SAFEs are RNs, NPs, PAs and residents at our institution. Anonymous, IRB-approved surveys were disseminated to SAFEs and EMF via email. Surveys collect demographic data and assess providers’ level of knowledge, perceptions of their knowledge, attitudes, emotions, perceived barriers to providing care, and preferences for continuing education regarding SAFE care. Data was collected using a REDCap database and analyzed using R 3.5.3. Comparisons were made using Chi-square tests, Student’s t-tests, and Wilcoxon rank-sum tests. Among SAFEs (n=16, 35% response rate), the average years of SAFE experience was 2.2, and 2 (13%) had completed at least 20 forensic exams in their career. Among faculty (n=30, 50.8% response rate), the average years of general emergency medicine practice was 10.9. None of the faculty with the most SAFE experience (ie, performed ≥20 exams in their career) have formal SAFE training (n=3, 1%). Overall, 33% of EMF have completed a SAFE course. This group was analyzed as faculty only, as they do not take call. There were no significant differences in knowledge, attitudes, or behaviors between faculty who completed a SAFE course and those who did not. A larger proportion of faculty reported feelings of high anxiety (70.0% vs. 13.3%, p<0.001) and high conflict (70.0% vs. 13.3%, p<0.001) when a survivor was triaged to their area and there was no SAFE vs. there was a SAFE present. When comparing EMF to SAFEs, there were no significant differences in knowledge regarding indications for drug-facilitated sexual assault (DFSA) kits, the role of advocates in evidence collection, post-discharge resources for survivors, or their role in determining whether SA occurred. However, a lower proportion of faculty, compared to SAFEs, rated themselves as knowledgeable about forensic documentation (46.7% vs. 87.5%, p=0.017) and DFSA kits (40.0% vs. 93.8%, p=0.001). Faculty also reported less competency in screening for sexual violence compared to SAFEs (p=0.014). The most common barriers to providing SAFE care for faculty include clinical management of all other patients in the ED (93.3%) and staffing (80.0%) and for SAFEs include staffing (68.8%) and paperwork (56.2%). This novel evaluation of providers’ knowledge, attitudes, and behaviors regarding the care of SA survivors demonstrates that EMF experience greater distress when caring for survivors in the absence of a SAFE and report less knowledge and competency in areas of care unique to SA patients. History of formal SAFE training did not mitigate these findings. This study highlights the importance of adequate SAFE coverage as well as a need for continuing and greater support and education to providers of care for SA survivors.