Barriers and Facilitators for Intimate Partner Violence Intervention in Adult Emergency Departments in One City

This qualitative study investigates current protocols, barriers, and facilitators for intimate partner violence (IPV) intervention at multiple adult emergency departments (EDs) in one city. Based on identified barriers and facilitators, structural changes are recommended for EDs to better support patients experiencing IPV.

We conducted semi-structured interviews with providers across disciplines, including physicians, nurses, and social workers, at three EDs in a large U.S. city: a public hospital, an academic center, and a community hospital. We also requested written protocols for IPV at participating hospitals. Participant interviews were transcribed, and an exploratory-descriptive content analysis was performed to identify barriers and facilitators to intervention. Each interview was coded by two readers, then reviewed by the research team until consensus on themes was reached.

We conducted 16 total interviews. Two of three hospitals provided written protocols for IPV; both protocols described steps for identifying, documenting, and intervening in IPV. Multiple barriers and facilitators were identified, including patient attitudes and behaviors, provider knowledge and training, variation in provider approaches, ED workflow, accessibility to external resources such as shelters, and interactions with the justice system.

Although EDs may have comprehensive protocols in place for responding to patients experiencing IPV, execution of interventions is modulated by provider, patient, and structural factors. Our study suggests that EDs can improve IPV interventions for patients by standardizing private interviews with patients, providing training that focuses on IPV legislation, policies, and resources, and investing in 24-hour social work coverage by professionals experienced in IPV intervention.