Highlights from #AAST2014 - Evaluation of Ceasefire

Congratulations to our resident John Kubasiak who gave a great poster presentation last evening.

ONE-YEAR EVALUATION OF THIRD PARTY VIOLENCE INTERVENTION PROGRAM IN A PUBLIC HOSPITAL

John C. Kubasiak MD, Reza Salabat MD, Andy Wheeler MS, Elizabeth Gwinn MD, Frederic Starr MD, Andrew Dennis DO, Dorion Wiley MD, Kimberly Nagy* MD, Faran Bokhari MBA,MD, Kimberly Joseph* MD, Cook County Hospital

Introduction: Injury prevention is a key component of the modern trauma center; patients who are victims of intentional injury have a 5 year re-injury rate as high as 45%. Recent attempts to decrease this rate have lead to the creation of hospital-based violence intervention programs (VIP). Our publicly-funded level 1 trauma center has been a member of a city wide VIP for 12 months. We sought to evaluate program effectiveness over this period and to investigate areas for improvement.
Methods: Over a 12 month period, patients who were seen at our publicly-funded level 1 trauma center and who were victims of intentional injury were offered enrollment with a third party violence intervention program (VIP) partner during their visit. Our hospital differs from other hospitals participating in the program in that we require written
consent from the patient for a referral. The trauma center also had two Masters-candidate Social Work interns on service during that period who interfaced with several of the referred patients. After 12 months of the partnership a phone survey of referred patients was conducted to evaluate program performance. Our primary outcome was successful enrollment with the VIP as evidenced by more than one outpatient follow-up. Secondary outcome measures included patients’ subjective feelings regarding the VIP and identification of needs addressed.
Results: A total of 205 patients consented and were referred who were identified as high-risk victims of intentional injury over the 12 month period, with 28 responses (n=22 or 79% GSW, n=2 or 7% SW, n=4 or 14% Blunt trauma). Of those contacted 35% (n=10) had no memory of referral to the VIP and were not contacted once discharged from hospital by the VIP; 9 requested another referral to VIP program. Those with any post-discharge contact by the VIP reported overall adequate follow up and that their
needs were addressed. Additionally 32% (n=9) with follow up were “strong supporters”; 42% (n=12) recommended services to similar patients. Patients with no recall saw trauma SW 10% of time (n=1); patients considered strong supporters had trauma SW 55% of time (n=9)
Conclusion: Our primary endpoint demonstrates low enrollment rates in third party VIP program; the need for written consent may have had a significant effect on this outcome. Contact with the hospital-based Social Work interns was highly correlated with successful post-discharge follow up by the VIP, suggesting the benefit of permanently placed in-house personnel to facilitate enrollment. Secondary outcomes were positive in those who successfully enrolled with the VIP. Our data also suggests a role for scheduled follow-up with those patients who are referred but do not have post-discharge contact with the VIP, as the majority of them requested a new referral. Future areas of investigation: survey of patients who declined referral to determine reasons for the initial refusal as well as the willingness to accept a new referral.