Violence Prevention and Intervention in the Emergency Department (ED): The Massachusetts General Hospital Experience

Background: Homicide is the second leading cause of death in 10-24 year olds and the third leading cause in 25-34 year olds in the United States. Violence-related injuries result in over 2 million ED visits/year. The cost of violence-related injuries and deaths total over $70 billion/year. Hospital-based interventions that capitalize on the “teachable moment” can be an effective form of secondary violence prevention.

Objective: To evaluate the impact of the ED-based Violence Intervention Advocacy Program (VIAP) at the Massachusetts General Hospital (MGH) in Boston, MA.

Methods: VIAP was created to provide brief ED interventions, case management follow-ups, and referrals. Data were extracted from interviews and follow-up points of contact with 246 ED patients presenting with violence-related injuries between January 2010 and December 2011.

Results: VIAP completed 996 inpatient/outpatient services, outreach phone calls, and referrals. Patients ranged from 13 to 62 years, with an average age of 24 years and 47% 10-24 year olds. 89% were male, 40% Caucasian, 37% Hispanic, and 16% Black. Of 185 adults not enrolled in educational programs, 70% were not formally employed. Although 176 patients reported alcohol and/or drug use, only 23 felt their injuries directly resulted from their use. Accurate determination of recidivism proved problematic. Injuries included 40 gunshot wounds, 93 stab wounds, and 113 assaults.

Conclusion: Hospital-based programs can be effective at interrupting violence; however data collection limitations thwart efforts to evaluate effectiveness. City-wide collaborations that standardize identifier data and allow patient tracking across non-affiliated hospitals would facilitate more accurate determinations of effectiveness.