Details Matter: A Quality Improvement Study on Screening for Intimate Partner Violence at a Labor and Delivery Hospital

Background: It is estimated that one in three women will experience intimate partner violence (IPV) in their life time. It is recommended that healthcare professional screen patients for IPV, but screening rates and positive disclosure rates remain low. Best practices for screening for IPV in the healthcare setting include screening alone, showing compassion and non-judgement, asking specific and direct questions, and using a framing statement before the screening occurs. Methods: A review of the screening protocol for IPV at a labor and delivery hospital revealed high screening rates (88%), low positive disclosure rates (0.43%), and that some best practices were not being followed. We utilized an iterative quality improvement process to update the IPV screening protocol to be more closely aligned with best practices. Changes included updating the security check-in process at the hospital to ensure that nurses had time alone with patients. After implementation of the new protocol, positive disclosure rates increased from 0.43% to 2.5%. Discussion: By focusing on how IPV screening was being conducted, we were able to achieve a modest increase in positive disclosure rates at a labor and delivery hospital. Involving the nursing staff and leadership in development of the new protocol and communication were key components in the adoption of the new protocol. Conclusion: Healthcare practices that screen for IPV and other social determinants of health should ensure that screening is conducted in a manner that aligns with best practices and is conducive to patients being comfortable with disclosing IPV and other social needs.