Abuse In Emergency Department Research Articles

Substance Use in Patients Admitted to the Psychiatric Emergency Department in Northern Iran

Background: Acute psychiatric problems are increasingly observed following substance abuse in emergency departments. To address this significant societal issue, it is essential to understand its various dimensions in order to develop comprehensive control policies. Objectives: This study aimed to evaluate substance use and its related factors in patients admitted to a psychiatric emergency ward in Sari, Mazandaran, Iran. Methods: In this cross sectional investigation, all patients who were admitted to the emergency department of Zare referral psychiatry hospital during the previous one year were studied. A checklist of demographic and psychiatric factors was completed for each patient based on their medical records. Urine rapid tests were routinely conducted in this department to screen for drug consumption. Descriptive statistics, central and dispersion indices, and the chi-square test were used to analyze the data. Results: A total of 578 cases, comprising 406 males (70.2%) and 172 females (29.8%), were examined. The mean age of patients was 34.7 ± 11.2 years. The most common symptoms reported were aggression (50.5%), insomnia (11.2%), paranoia (10.7%), and self-talk (8.1%), respectively. The most frequent final clinical diagnosis was bipolar disorder in 145 cases (25.1%), followed by schizophrenia in 131 cases (22.7%), and substance-induced psychotic disorder in 63 cases (10.9%). In the substance use screening among patients, the urine test was positive for morphine in 17.6% of the patients. Methamphetamine, methadone, and cannabis tests were positive in 16.1%, 9.5%, and 3.5% of cases, respectively. Among patients with positive urine tests (for methamphetamine, methadone, or morphine), the most common clinical diagnosis was substance-induced psychotic disorder, followed by schizophrenia. Schizophrenia and substance-induced psychotic disorder were the two most common diagnoses in patients with positive cannabis urine tests, respectively. Conclusions: The high rate of substance abuse among psychiatric emergency patients, often co-occurring with other psychiatric disorders, the high prevalence of psychosis, and the behavioral risks associated with these patients emphasize the need for special attention to this biopsychosocial problem.

Screening for abuse in Emergency Departments: A pending issue

Screening for abuse in Emergency Departments: A pending issue

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic violence and abuse survivor who seeks help. The physical characteristics of domestic violence and abuse are often easier to identify and manage, but emotional and psychological aspects of domestic violence and abuse are often more complex and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose. Domestic violence and abuse has been shown to have a direct impact on the health and well-being of survivors who will often access emergency department services with direct injuries and associated medical conditions. This article is relevant to those working in the emergency department in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence survivors. Furthermore, patients do not always disclose domestic violence and abuse even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well-maintained and effective reporting system for instances of suspected and disclosed domestic violence and abuse in order that staff can provide the appropriate care and support. Emergency department staff often deal with complex cases, this includes different aspects of domestic violence and abuse including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist emergency department clinical staff to manage and discuss instances of domestic violence and abuse in their workplace and their interactions with domestic violence and abuse patients. Whilst training for emergency department staff is welcomed, there also needs to be a greater awareness of the potential complexity of domestic violence and abuse presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear domestic violence and abuse assessment and referral mechanisms should be embedded into clinical practice, including emergency department, as described in the UK National Institute of Clinical Excellence guidelines (2014). Overall improvements in reporting mechanisms in emergency department for the identification, management and support for domestic violence and abuse survivors would add to the collective and growing body of evidence surrounding domestic violence and abuse and their presentations within healthcare settings. Such measures would enable those working in emergency department to support disclosure of domestic violence and abuse more effectively.

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.

Emergency department-based interventions for women suffering domestic abuse: a critical literature review.

Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.

Diagnosis of Elder Abuse in U.S. Emergency Departments.

To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets. Retrospective cross-sectional analysis. U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). All ED visits of individuals aged 60 and older. The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse. In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012-0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits. The proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.

Residents' Experiences of Abuse and Harassment in Emergency Departments.

The widespread epidemic of emerging abuse in Emergency Departments (ED) toward residents generates negative effects on the residents' health and welfare. The purpose of this study was to determine and highlight the high prevalence of abuse and harassment toward Emergency residents. In 2011, a multi-institutional, cross-sectional study was conducted at seven Emergency Residencies of central hospitals in Iran. Residents were asked about their age, marital status, postgraduate year (PGY) levels, and work experiences before residency. Prevalence of abuse in four categories was evaluated: verbal abuse; verbal and physical threat; physical assault and sexual harassment; and by whom. The data were analyzed by SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Two hundred fifteen of the 296 residents (73%) completed the survey. The prevalence of any type of abuse experienced was 89%; 43% of residents experienced verbal and physical threats, 10% physical assault, and 31% sexual harassment. Verbal abuse and verbal and physical threats without the use of weapons were higher in men in comparison with women ( p< .04). Women were more likely than men to encounter sexual harassment (31% vs. 7%, p< .01). Among the sexual harassment categories, sexual jokes (51%) were the most prevalent between residents. Junior residents (PGY-1) were more likely to experience abuse than senior residents (PGY-2 and PGY-3; p< .01). Patients and their companions were the main agents of abusive behaviors. Abuse and harassment during residency in ED are highly prevalent. Educational programs and effective preventive measures against this mistreatment are urgently required.

Evaluation of Bite Marks in Terms of Child Abuse in Emergency Departments

Evaluation of Bite Marks in Terms of Child Abuse in Emergency Departments

IS-058 Screening On Child Abuse In Europe

The emergency department is the main system for crises based health care visits. It is estimated that 0.2%–10% of ED visits concern child abuse. Systematic screening might improve the detection rate, but studies are scarce. Furthermore different non-validated screening tool are used. <h3>Objective</h3> to validate a 6 item screening tool (the ESCAPE instrument), to improve screening by training of ED nurses and to evaluate detection of child abuse. <h3>Methods</h3> Based on a systematic review the ESCAPE screening tool was developed. The validity was evaluated in the Netherlands in 18,275 children. Communication training sessions of the ED nurses were implemented and the effect on the screening and detection rate was evaluated. <h3>Results</h3> The predictive value of the six screening items (e.g. consistent history, delay in seeking medical help, injury fits with developmental level, interaction, top-toe exam, doubt about safety) was high (sensitivity 0.80, specificity 0.98). The detection rate in children screened for child abuse was 5 times higher than that in children not screened. In the study population of 104.028 children (7 ED’s), the screening rate increased after introduction of the ESCAPE instrument from 20% to 67%. Significant trend changes were observed after training of the nurses and legal requirements for screening. The suspicion of child abuse detected by screening were justified in the majority. <h3>Conclusions</h3> Systematic screening for child abuse in emergency departments is effective. The ESCAPE instrument and ED staff training are recommended to improve screening and detection rate of child abuse.

Accuracy of a screening instrument to identify potential child abuse in emergency departments

Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals’ Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR=189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.

Facilitators and barriers to screening for child abuse in the emergency department

BackgroundTo identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.MethodsThis qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.ResultsLack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.ConclusionsED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.

Residents’ experiences in dealing with abuse in emergency department: a survey in Iran hospitals

BackgroundAbuse in Emergency Department (ED) as a widespread phenomenon, has negative effects on ED residents. This issue pertains to Western as well as Asian countries.ObjectiveThe purpose of this study was...

Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments

Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection rate of child abuse. In an intervention cohort study, children aged 0 to 18 years visiting the emergency departments of 7 hospitals between February 2008 and December 2009 were enrolled. We developed a screening checklist for child abuse (the "Escape Form") and training sessions for nurses; these were implemented by using an interrupted time-series design. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children. A total of 104028 children aged 18 years or younger were included. The screening rate increased from 20% in February 2008 to 67% in December 2009. Significant trend changes were observed after training the nurses and after the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was 5 times higher than that in children not screened (0.5% vs 0.1%, P < .001). These results indicate that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Both a legal requirement and staff training are recommended to significantly increase the extent of screening.

Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments

Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments

Detection of Child Abuse in Emergency Departments: A Multi-Centre Study

Detection of Child Abuse in Emergency Departments: A Multi-Centre Study

Detection of child abuse in emergency departments: a multi-centre study

ObjectiveThis study examines the detection rates of suspected child abuse in the emergency departments of seven Dutch hospitals complying and not complying with screening guidelines for child abuse.DesignData on demographics,...

Successful e-learning programme on the detection of child abuse in Emergency Departments: a randomised controlled trial

ObjectiveTo evaluate the effectiveness of an electronic learning (e-learning) programme on the performance of nurses in the recognition of child abuse in a simulated case in the Emergency Department (ED).DesignBlinded,...

P.1.h.006 Detection of substances of abuse in emergency department: is there an increasing the use of benzodiazepines?

P.1.h.006 Detection of substances of abuse in emergency department: is there an increasing the use of benzodiazepines?

Staff 'reluctant to report violence'.

NHS staff are reluctant to report violence because of work pressures, lack of support from managers and acceptance of verbal abuse in emergency departments, a report reveals.

Child protection procedures in emergency departments

Background:Emergency departments (EDs) may be the first point at which children who have been subject to abuse or neglect come into contact with professionals who are able to act for...