Sexual Assault Exams

[lawj]

Hi everyone,

I was hoping to get some input from those of you practicing in the community about the sexual assault examination. Do any of you perform these? Do you have dedicated Forensic Nurses who perform them for you. If you don't have a Forensic Nurse, do you transfer to a facility that does? If not, do you perform it yourself. If so, how do you handle the time spent on the exam when you have an ED to run? Do you call a colleague in? Do you wait until the end of your shift?

Thanks for any insight you all can offer!

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[em1234]

current job: no SANE (sexual assault nurse examiner) at my hospital, so they get transferred. I don't do the exam
new job: SANE available in house 24/7.

 

[emd123]

Hi everyone,

I was hoping to get some input from those of you practicing in the community about the sexual assault examination. Do any of you perform these? Do you have dedicated Forensic Nurses who perform them for you. If you don't have a Forensic Nurse, do you transfer to a facility that does? If not, do you perform it yourself. If so, how do you handle the time spent on the exam when you have an ED to run? Do you call a colleague in? Do you wait until the end of your shift?

Thanks for any insight you all can offer!

Error

 

[Arcan57]

I just found out today that we are losing our SANE team for the entire system starting in June. I can't wait to start trying to cover shifts because our docs are getting subpoenaed constantly (we see 2-3 per day) and the extra time it takes to do a forensic exam.

 

[Droperidol]

At my shop we transfer to another facility that has SANE

 

[DocEspana]

I was always under the impression that it's a requirement that it can be transferred to a hospital with a SANE nurse. Im currently at a very large community hospital (its the county hospital) and all of the surrounding hospitals, including two very large Academic centers, transfer all of their sexual assault patients to us. We were always told that it was a requirement that it be seen by a SANE nurse.

 

[Arcan57]

Texas law requires all EDs to be able to take care of SA victims although that hasn't stopped a variety of neighboring EDs from transferring to us.

 

[deleted109597]

Texas law requires all EDs to be able to take care of SA victims although that hasn't stopped a variety of neighboring EDs from transferring to us.

Yeah, it's a contentious issue. The verbiage of that law isn't crystal clear, so TMA and TCEP are working on fixing that. SANE nurses aren't cheap, but they're cheaper than docs. We used to have one on call.

 

[Arcan57]

Yeah, it's a contentious issue. The verbiage of that law isn't crystal clear, so TMA and TCEP are working on fixing that. SANE nurses aren't cheap, but they're cheaper than docs. We used to have one on call.

Apparently our hospital is trying to deal with the loss of dedicated SANE nurses by training up our own nurses. I'm cautiously optimistic that we're not going to be completely hosed by the change. I think evidence quality will suffer, but given the deplorable state of kit processing in Houston that may not actually be noticed.

 

[WilcoWorld]

I donate money to our local SANE program to keep it going. It is invaluable.

In residency, we did these exams ourselves. While they are a PITA, they are certainly within the capability of any EM doc. So transferring a patient to a SANE center sounds like a major dump to me. It's not being done because the local doc can't do it, it's being done because the local doc doesn't want to do it.

 

[deleted128562]

Well in fairness to the "local doc" who "doesn't want to do it", that may be because he or she has 7 other patients to see and 15 people sitting in the lobby. It's not good resource utilization, nor is it good care for those 22 other people for the doctor to spend half an hour doing a sane exam.

 

[turkeyjerky]

Which begs the question, why are these exams delegated to Emergency Rooms? I mean, obviously we should be treating these patients for any injuries sustained or STIs they've been exposed to, but shouldn't a forensic exam be performed by a forensic practitioner (nurse, doctor or other) employed by the police or prosecutor's office?

 

[Arcan57]

Which begs the question, why are these exams delegated to Emergency Rooms? I mean, obviously we should be treating these patients for any injuries sustained or STIs they've been exposed to, but shouldn't a forensic exam be performed by a forensic practitioner (nurse, doctor or other) employed by the police or prosecutor's office?

Because we are the dumping ground for things the police don't want to deal with that have even quasi-medical implications. Drunk, high, crazy all come for us to assume the risk prior to them being dispositioned somewhere that can actually help them. I think SA exams fall somewhere in the middle on the spectrum of "commit assault by drawing their blood without consent for an ETOH level" and agitated delirium regarding actual need for emergency medical care.

 

[WilcoWorld]

Well in fairness to the "local doc" who "doesn't want to do it", that may be because he or she has 7 other patients to see and 15 people sitting in the lobby. It's not good resource utilization, nor is it good care for those 22 other people for the doctor to spend half an hour doing a sane exam.

Having been the local doc in a very busy ED, I am fully aware of this. This same argument can be used to call in ENT for a facial lac or plastics for a hand lac that you could repair, but feel like you're too busy. Is it the right thing to do in some cases? Yes. Is it implicitly saying "my time is more valuable than yours?" Yes.

 

[deleted128562]

Having been the local doc in a very busy ED, I am fully aware of this. This same argument can be used to call in ENT for a facial lac or plastics for a hand lac that you could repair, but feel like you're too busy. Is it the right thing to do in some cases? Yes. Is it implicitly saying "my time is more valuable than yours?" Yes.

Perhaps this is where you and I see things differently. I do not think it is saying "my time is more valuable than yours". I think it is simply recognizing that different people have different parts to play. Say I have a complex hand lac, and also have 10 other patients to see. Can the plastics guy sew the hand lac? Yes he can. Can the plastics guy see my other 10 ED patients? No he can't. So I have a choice. I can either sew the complex hand lac myself while letting my other 10 patients sit, or I can call plastics and they can sew the hand while I see the other 10 people who need to be seen. Is that dumping? I don't think so. Is that saying my time is more valuable than his? Again I don't think so. It is simply recognizing that this is the best way to provide the best care for everyone. Same thing with the SANE nurse - can they see my other 10 patients who are waiting to be seen? Nope. Can they do the SANE exam? Yep.

And really if you want to make that argument, then -- When you ask the nurse to start the IV instead of doing it yourself, aren't you saying that your time is more valuable than his? When you ask the US tech to do a RUQ scan instead of doing it yourself, aren't you saying your time is more valuable than his? When you ask the tech to do an EKG instead of doing it yourself, aren't you saying your time is more valuable than hers?

 

[WilcoWorld]

And really if you want to make that argument, then -- When you ask the nurse to start the IV instead of doing it yourself, aren't you saying that your time is more valuable than his? When you ask the US tech to do a RUQ scan instead of doing it yourself, aren't you saying your time is more valuable than his? When you ask the tech to do an EKG instead of doing it yourself, aren't you saying your time is more valuable than hers?

Yes on all counts.

And allow me to reiterate - I said that this is the right thing to do in some cases.

 

[Rendar5]

Honestly I've never done a Sexual assault exam and have no clue what to do if I had to do one. Do you really want me to be on the stand testifying ? It's better for the victim that someone trained do the exam.

 

[CommunityED]

We dont have SANE RNs. My feeling is like Rendar's. I doubt I would hold up on the stand if truly necessary.