Study finds vast majority of violent incidents treated in the ED are never reported to police

As hospitals increasingly approach violence as a public health issue, a new study suggests doctors and nurses occupy a unique position to capture unreported incidents and aid in a communal approach to violence prevention.

The study, described in a research letter published in JAMA Internal Medicine, found upward of eight in ten violent incidents resulting in emergency department (ED) treatments went unreported to police. The study describes that number as “considerably greater” than previous findings have suggested, but comparable to other studies undertaken using the Cardiff Model it employed.

In the wake of high-profile mass-casualty events, doctors have become increasingly vocal about gun violence in particular. Recent social media battles between doctors and the National Rifle Association regarding whether or not physicians should speak out on gun violence have focused the debate in the middle of a sociopolitical minefield.

While gun deaths grab the headlines, the new study suggests other manifestations of violence continue to take place under society’s collective radar.

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A step back to take in the full scope of the problem may provide a clearer view of how hospitals fit into the violence prevention landscape, according to Daniel T. Wu, M.D., associate professor of emergency medicine at Emory University and chief medical information officer for Grady Health System.

“If you don’t know the scope of the issue you’re trying to address, you’re not going to be able to solve it,” Wu told FierceHealthcare. He added that, from a healthcare perspective, all types of violence are connected: Physicians may treat an injury committed by a gun on one occasion, a knife on another and a bat on a third.

Wu sees part of the hospital’s evolving role in violence prevention as an outgrowth of providers’ increased attention to social determinants of health.

“The risk is not when they get to us,” he said. “I can sew up their injury or we can fix the broken bones, but that doesn’t prevent it from occurring again—that’s just taking care of the medical part. Really, preventing the violence and the injuries should be our goal.”

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In line with those goals, the study tried to identify hot spots in the community where violence occurs and then to provide that information to police and community leaders in order to address the issue before it occurs. Wu sees promise in that type of approach, with hospital insights driving community intervention to solve a large-scale, social and political challenge.

In particular, the Cardiff Model has begun to take root in the U.S. as a way to tap ED data to predict and prevent violence. 

“If you ask the creator of this model, Dr. Jonathan Shepard, in Cardiff, Wales, he’ll say the secret sauce that drives this program and makes it effective is the community partnerships, and really giving the community their own data so they have the insight to make effective changes at the community level,” Wu said.