Introducing a new model of care for patients presenting to the Emergency Department requiring medical and forensic responses following sexual assault

Ms Keryn Jones, Ms Erica Rootham, Ms Patsy Jang, Karen Lambert, Leannie Tjong

1St George Hospital, Kogarah, Australia

In 2017, the Southern Sydney Sexual Assault Service (SSSAS) was challenged by an inconsistency in access to a suitably qualified medical clinicians to provide a timely and consistent medical and forensic management of adults who are victims of sexual assault.

Historically, adults presenting after sexual assault to the SSSAS were managed by Obstetrics and Gynaecology (O&G) Registrars. Increasingly competing demands for O&G services within the hospital resulted these clients waiting extended periods in the emergency department to be examined and provided care.

Furthermore, in the instance where a client had concurrent injuries such as soft tissue or musculoskeletal injuries, the injury management would be provided by an emergency clinician and the forensic examination/gynaecological management by the O&G team, resulting in fragmented care.

Consequently, an innovative strategy was trialled with the aim of providing a timely, high-quality, consistent and cost-effective service to sexual assault victims presenting within the SESLHD.

The SSSAS in conjunction the St George Hospital Emergency Nurse Practitioners, (EDNP’s) introduced a Sexual Assault Nurse Examiner/Nurse Practitioner (SANE/NP) model of care in November 2018.  The EDNP’s undertook Graduate Certificate training and upon successful completion, began managing these clients in collaboration with SSSAS.

This model differs from the traditional Registered Nurse/SANE model and provides a more comprehensive care episode than that of the previous model.The EDNP’s manage both the forensic examination and medical treatment needs of the clients within their current NP scope of practice.

As a result, the SANE/NP and SSSAS counsellor complete the total care episode and ongoing follow up. They provide holistic and trauma informed care, promoting a seamless approach to the client’s immediate and ongoing medical and psychological needs, reducing client anxiety and increasing emotional safety.

Building the SANE role into the EDNP Scope enables the service to work within the ED model of crisis work.  It is highly innovative and is the first of its kind nationally.

Anecdotal reports by clients of their experiences has been is overwhelmingly positive.  A formal review of the model is planned to commence in November 2019, 12 months after implementation.


Biography:

As an Emergency Nurse for over 20 years, Keryn found her niche as an Emergency Nurse Practitioner in 2006 and hasn’t looked back.  Over her 20 + years in emergency nursing, her roles have included Nurse Educator for Division of Medicine, Nurse Practitioner Masters’ Program Coordinator and Facilitator, Nurse Practitioner Project Officer for the Local Health District and she has collaborated on numerous research publications, local and statewide policies and emergency/trauma care text book chapters.  Despite this, Keryn tries not to be totally consumed by work. She also a lover of good wine and in her spare time can be found hanging upside down not so gracefully on aerial tissu/trapeze, all the while hoping that she does not end up as a patient at her own workplace!

Erica Rootham has worked in emergency departments for the past 17 years both in Australia and overseas. She began her journey to becoming a Nurse Practitioner in 2013, spending time developing her expertise as a TNP with the Geriatric Flying Squad and in the Emergency Department.  Just when she thought her formal study was completed, she found herself in 2018 completing a Graduate Certificate in the medical and forensic management of adult sexual assault.  In her spare time Erica does not enjoy cooking, nor long walks on the beach. She prefers investigating and researching her next travel destinations or watching documentaries.