Urgent care-seeking and injury severity for intimate partner violence during COVID-19: a Canadian retrospective chart review.

BACKGROUND: Early reports raised alarms that intimate partner violence (IPV) increased during the COVID-19 pandemic, but initial studies showed that visits to emergency departments (EDs) decreased. This study assessed the impact of the prolonged pandemic and its associated restrictions on both rates of urgent care-seeking and injury severity for IPV. METHODS: Data from the Kingston Health Sciences Centre's (KHSC) ED were utilized to compare IPV presentations during 'Pre-COVID' (December 17, 2018 - March 16, 2020) and 'COVID' (March 17, 2020 - June 16, 2021), as well as three periods of heightened local restrictions: 'Lockdown-1' (March 17 - June 12, 2020), 'Lockdown-2' (December 26, 2020 - February 10, 2021) and 'Lockdown-3' (April 8 - June 2, 2021). The primary outcomes were incidence rate of IPV visits and injury severity, which was assessed using the Clinical Injury Extent Score (CIES) and Injury Severity Score (ISS). RESULTS: A total of 128 individuals were included. This sample had mean age of 34 years, was comprised of mostly women (97%), and represented a variety of intimate relationship types. Some individuals presented multiple times, resulting in a total of 139 acute IPV presentations. The frequency of IPV visits during COVID was similar to the Pre-COVID time period (67 vs. 72; p = 0.67). Incidence rate was 13% higher during COVID, though this difference was non-significant (6.66 vs. 5.90; p = 0.47). IPV visit frequency varied across lockdown periods (11 in Lockdown-1, 12 in Lockdown-2 and 6 in Lockdown-3), with the highest incidence rate during Lockdown-2 (12.71). There were more moderate and severe injuries during COVID compared to Pre-COVID, but mean CIES was not statistically significantly different (1.91 vs. 1.69; p = 0.29), nor was mean ISS (11.88 vs. 12.52; p = 0.73). CONCLUSIONS: During the 15-months following the start of COVID-19, there were small, but non-significant increases in both incidence rate and severity of IPV presentations to the KHSC ED. This may reflect escalation of violence as pandemic restrictions persisted and requires further investigation.

Addressing microaggressions with simulation: a novel educational intervention.

There is an urgent need for education around equity, diversity, inclusivity, indigeneity, and accessibility (EDIIA). One important facet of this is gender-related microaggressions, which are a common occurrence in the emergency department. Most emergency medicine residents receive few opportunities to discuss, understand, and approach these occurrences in the clinical setting. To address this, we created a novel immersive session exploring gender-based microaggressions through a simulation experience followed by reflective teaching to foster allyship and practice tools for responding to microaggressions. An anonymous survey was subsequently distributed to elicit feedback, which was positive. After this successful pilot, next steps include creating sessions to address other microaggressions. Limitations include implicit biases of facilitators and ensuring that facilitators can engage in brave spaces and open conversations. Others trying to integrate gendered microaggression training into their EDIIA curricula could model our innovation.

RéSUMé: Il existe un besoin urgent d'éducation sur l'équité, la diversité, l'inclusivité, l'indigénéité et l'accessibilité (EDIIA). Les micro-agressions liées au genre, qui sont monnaie courante dans les services d'urgence, en sont une facette importante. La plupart des résidents en médecine d'urgence ont peu d'occasions de discuter, de comprendre et d'aborder ces événements en milieu clinique. Pour y remédier, nous avons créé une nouvelle session immersive explorant les micro-agressions basées sur le genre par le biais d'une expérience de simulation suivie d'un enseignement réflexif pour favoriser l'alliance et la pratique d'outils pour répondre aux micro-agressions. Un sondage anonyme a ensuite été distribué pour obtenir des commentaires, qui ont été positifs. Après ce projet pilote réussi, les prochaines étapes comprennent la création de séances pour aborder d'autres micro-agressions. Les limites comprennent les préjugés implicites des animateurs et la garantie que les animateurs peuvent s'engager dans des espaces courageux et des conversations ouvertes. D'autres personnes qui tentent d'intégrer une formation sur les micro-agressions sexistes dans leur programme EDIIA pourraient s'inspirer de notre innovation.

Intimate Partner Violence and Human Trafficking: Trauma We May Not Identify.

Intimate partner violence and human trafficking commonly affect patients presenting to the emergency department including the trauma bay. Although these forms of violence and exploitation are not always the underlying cause of that particular emergency department encounter, screening is important regardless of the presenting condition because this presentation may be the only opportunity to receive help and ultimately plants the seed for future access to help regardless of what a patient chooses to do following this first encounter. There are important medical care considerations in these patients beyond trauma bay procedures that can make the difference in saving a life.

Patient and Provider Emergency Care Experiences Related to Intimate Partner Violence: A Systematic Review of the Existing Evidence.

Intimate partner violence (IPV) is a public health problem that has devastating physical, psychological, and economic consequences. The emergency department (ED) is an important point of contact for individuals experiencing IPV. However, there are few studies synthesizing interactions between patients experiencing IPV and providers. We aimed to summarize the existing evidence regarding (1) ED care experiences of patients with a history of IPV and (2) experiences of ED providers interacting with them. The secondary aim of this review was to evaluate high-quality care barriers and facilitators and to elucidate common causes of care avoidance. A literature search of peer-reviewed electronic databases was undertaken. Inclusion criteria consisted of studies detailing IPV-related patient or provider experiences surrounding ED visits. Articles published before 2000 or unavailable in English/French were excluded. A total of 772 studies were screened, yielding a final number of 41 studies. Negative patient experiences arose from individual-, institutional-, and system-level issues, commonly including adverse provider behavior. Negative provider experiences stemmed from individual-, institutional-, and system-level issues, such as a lack of knowledge and lack of infrastructure. Facilitators to positive patient experiences included interacting with empathetic providers, having privacy, and receiving timely specialized care. Facilitators to positive provider experiences included feeling well-equipped to manage IPV and having policies leading to appropriate care. Negative ED care experiences reveal inadequate care quality, ultimately leading to secondary victimization of individuals experiencing IPV. This review also uncovered important literature gaps regarding experiences of those who identify as equity-deserving.