268548 Violence Prevention and Intervention in the Emergency Department (ED): The Massachusetts General Hospital Experience

Monday, October 29, 2012

Wendy Macias Konstantopoulos, MD, MPH , Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
Amanda Breen, MS , Violence Intervention Advocacy Program, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
William Binder, MD , Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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.

Learning Areas:
Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Describe the patient population served by MGH VIAP, their injuries, and potential associated risk factors. 2. Explain the various components and services of a hospital-based violence prevention & intervention program. 3. Identify the challenges of data collection and analyses, and suggest ways in which similar hospital-based violence programs could collaborate to more accurately evaluate their impact on the community.

Keywords: Violence Prevention, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Violence Intervention Advocate for the program described.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.