• Kathryn Hinsliff-Smiith and Selecia Kench.
• University of Nottingham, Derby, United Kingdom.
• Emerg Med J. 2014 Sep 1;31(9):787.

Objectives & BackgroundSignificant numbers of people attend ED either as a direct result of domestic violence and abuse (DVA) or related admissions, for example self-harm (Boyle et al, 2006, Boursnell and Prosser, 2010). However, effective management remains problematic and as Gibbons (2011) has highlighted DVA often goes unreported by ED staff. The recent National Institute of Health and Care Excellence (NICE) (2014) guidance Domestic violence and abuse […] has identified that front line health care professionals will have a pivotal role and responsibility in the management of DVA in the future. The aim of our research therefore was to gather evidence regarding current practice in the recognition and management of DVA within ED in order to develop recommendations for service development through the following questions:How are survivors of DVA currently identified and managed within the ED?What systems can be put into place to maximize recognition and effective support within this context?MethodsA qualitative exploratory study involving in-depth interviews with ED clinical staff (n=11) and focus groups with survivors of domestic abuse (n=6) who had attended ED in order to understand experiences and identify factors influencing effective recognition and assessment within ED. A pre-piloted aide memoire was used to guide the interviews and focus groups. Data were analyzed using Framework (Ritchie and Lewis, 2012).ResultsInterviews identified a number of themes with clinical staff highlighting that it was emotionally and professionally 'challenging' to manage disclosure, expressed anxiety about 'wanting to do the right thing' and were cognizant of the organizational constraints of 'managing time'. Survivors had first-hand experience of ED attendance and discussed how they did not disclose to ED staff for a number of reasons including guilt about repeated ED attendance as a result of their injuries and 'time wasting', not being able to respond to staff advice to 'leave abusive partners' and the lack of opportunity 'privacy' within the ED environment.ConclusionA number of barriers exist including cultural and organizational structures which mediate against effective assessment and support. The recent NICE (2014) guidelines provide a potential platform to transform effective assessment and support for survivors by ED staff. Findings of the study and implications for service and practice development will form the basis of the presentation.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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