Developing a Strangulation Protocol for an Emergency Department

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Title: Developing a Strangulation Protocol for an Emergency Department

Presenter: Edrienne Besagar, Xavier University

Student Level: Masters Presentation

Type: Poster

Abstract: The purpose of this scholarly project is to develop a strangulation protocol that can be adopted by a community-based Emergency Department (ED) and integrated to other EDs within a multi-facility university hospital system in the Pacific Northwest. By standardizing the care of non-fatal strangulation (NFS) survivors, the desired outcome is to increase the quality of care and produce lower morbidity and mortality rates among intimate partner violence (IPV) survivors. The target population of this scholarly project are patients with a chief complaint consistent with strangulation injury. A strangulation protocol will be used as the intervention to produce the desired outcome of effectively detecting fatal injuries and future health consequences while also improving the quality of the forensic investigation. Adopting an integrated evidence-based strangulation protocol used across all facilities within a multi-hospital system provides a benefit for the hospital system and the community by eliminating inefficiency across the care continuum and creating better patient outcomes via use of evidence-based clinical decision-making tools as the standard of care.

The ED facility in question consisted of a sexual assault policy, which lacked a clinical decision-making tool to guide the care of patients who presented with strangulation as the chief complaint. Additionally, screening in triage lacked specific questions to address strangulation among those with a complaint of intimate partner abuse, sexual assault, or domestic violence. I notified the Nurse Educator/Trauma Coordinator of this gap in care and we both agreed to collaborate for the purpose of creating a strangulation protocol. For this project, I proposed the use of the Danger Assessment-5 (DA-5) as a triage tool and a clinical decision-making tool to aid the effective identification, evaluation, and treatment of adult NFS survivors. As the forensic nurse investigating the deficits in the continuum of care, I completed a review of the literature to locate the evidence-based tools to use in practice.