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Clinician Attitudes and Limitations

Joel A. Fein, MD; Kenneth R. Ginsburg, MD, MSEd; Meghan E. McGrath; Frances S. Shofer, PhD; John C. Flamma, Jr, MD; Elizabeth M. Datner, MD

Arch Pediatr Adolesc Med. 2000;154:495-498.

Objective  To assess emergency department (ED) clinicians' attitudes and behaviors regarding identification, assessment, and intervention for youth at risk for violence in the ED.

Design  Anonymous, cross-sectional written questionnaire.

Setting  The EDs of 3 urban hospitals.

Subjects  Emergency medicine residents and faculty, pediatric residents, pediatric emergency medicine fellows and faculty, and ED nurses.

Results  A total of 184 (88%) of 208 clinicians completed the questionnaire. Only 15% correctly recognized the lack of existing protocols for addressing youth violence. Clinicians reported being most active in identification of at-risk youth (93% asking context of injury and 82% determining relationships of victim and perpetrator), with pediatricians being more active than general ED clinicians (87% vs 68%; P<.01). Clinicians less often reported performing assessments or referrals of at-risk youth. Nurses and physicians were no different in their reported identification, assessment, or referral behaviors. Barriers identified include concern over upsetting family members, lack of time or skills, and concern for personal safety. Additional clinician training, information about community resources, and specially trained on-site staff were noted by respondents as potential solutions.

Conclusions  Emergency department clinicians recognize the need for evaluation of youth at risk for violence. They are able to identify violently injured youth, but less often perform risk assessment to guide patients to appropriate follow-up resources. Further investigation should address clinician barriers to the complete care of violently injured youth in the ED.

From the Departments of Pediatrics (Drs Fein and Ginsburg and Ms McGrath) and Emergency Medicine (Drs Shofer, Flamma, and Datner), The University of Pennsylvania School of Medicine, Philadelphia, and Divisions of Emergency Medicine (Dr Fein and Ms McGrath) and Adolescent Medicine (Dr Ginsburg), The Children's Hospital of Philadelphia.

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