The emergency department (ED) serves as the main source of care for patients who are victimsof interpersonal violence. As a result, emergency physicians across the nation are at the forefrontof delivering care and determining dispositions for many at-risk patients in a dynamic healthcareenvironment. In the majority of cases, survivors of interpersonal violence are treated and dischargedbased on the physical implications of the injury without consideration for risk of reinjury and thestructural drivers that may be at play. Some exceptions may exist at institutions with hospital-basedviolence intervention programs (HVIPs). At these institutions, disposition decisions often includeconsideration of a patient’s risk for repeat exposure to violence. Ideally, HVIP services would beavailable to all survivors of interpersonal violence, but a variety of current constraints limit availability.Here we offer a scoping review of HVIPs and our perspective on how risk-stratification could helpemergency physicians determine which patients will benefit most from HVIP services and potentiallyreduce re-injury secondary to interpersonal violence.

ABSTRACT

Introduction: Emergency department (ED) staff are at a high risk for compassion fatigue (CF) due to a work environment that combines high patient acuity, violence, and other workplace stressors. This multi-faceted syndrome has wide-ranging impacts which, if left untreated, can lead to adverse mental health conditions including depression, anxiety, and substance use disorders. However, the majority of studies examining CF look solely at clinicians; as a result, there is no information on the impact of CF across other roles that are involved in supporting patient care. We conducted this study to establish the prevalence of CF across both clinical and non-clinical roles in the adult ED setting.

Methods: For this single institution cross-sectional study, all full- and part-time ED staff members who worked at least 50% of their shifts in the ED or within the adult trauma service line were eligible to participate. Using the Professional Quality of Life (ProQOL-5) scale, which measures CF via compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS), we assessed for group differences between roles using non-parametric one-way ANOVA.

Results: A total of 152 participants (response rate = 38.0%) completed the survey. This included attending physicians (n = 15, 9.7%), resident/fellow physicians (n = 23, 15.1%), staff nurses (n = 54, 35.5%), emergency technicians (n = 21, 13.8%), supportive clinical staff (n = 28, 18.4%), and supportive ancillary staff (n = 11, 7.2%). Across all roles, the majority of respondents had average levels of BO (median = 25.0, IQR 20.0 – 29.0) and STS (median = 23.0, IQR 18.0 – 27.0) coupled with high levels of CS (median = 38.0, IQR 33.0 – 43.0). There was a difference in CS by role (p = .01), with nurses reporting lower CS than attending physicians. STS also differed by role (p = .01), with attending physicians reporting lower STS than both emergency technicians and nurses. Group differences were not seen in BO.

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