Developing Clinical Guidelines for Follow-Up Care for Sexual Assault Patients in a Primary Care Setting

Sexual assault (SA) is a persistent problem in the United States and in the Salt Lake City, Utah area; impacting one in five women during their lifetime. National and international organizations recommend that patients who have been sexually assaulted follow-up with their primary care providers; however there are no primary care provider protocols, or an official clinic where sexual assault nurse examiners (SANE) refer patients following the exam. The intent of this project is to develop provider protocols for follow-up care and initiate these protocols in a primary care clinic where SA patients will be referred by SANEs at the initial exam. The implementation of follow-up protocols and an official clinic will improve continuity of care for SA patients and improve their health outcomes after a traumatic life event. The objectives of this project included developing provider protocols to incorporate current evidenced-based care for the initial 2-week follow-up visit after a SA. A primary care clinic was enlisted to be the official follow-up SA clinic in the Salt Lake valley, where SANEs will refer patients for the initial follow-up visit after a SA. In addition, a local SANE organization was educated on the protocol and about providing appropriate referral to the participating SA clinic. Lastly, an application was submitted to present the protocols use at the Snowbird CME Conference in August 2016, in Snowbird, Utah. The review of literature identified that women who have been sexually assaulted have an increased risk of medical and mental complications during their lifetime. Multiple studies and national health organizations identified the indications for SA follow-up care, which included testing and evaluation for infection and a thorough evaluation of psychological and social support. Unfortunately, through extensive literature review, no protocols providing specific post-assault follow-up care in a primary care setting were found. Methods for reaching the objectives of developing and implementing a protocol included: enlisting content experts and performing a comprehensive literature review that was then used to develop the protocol. A local SANE organization agreed to use and support the protocol by referring patients to the enlisted clinic. A primary care clinic agreed to be an official follow-up clinic and use the developed protocol. The evaluation of this objective included the submission of the completed protocol to the project chair and clinic's assistant medical director. The assistant medical director approved the clinical protocol and supportive material. The protocol was presented to clinic providers and the SANE organization, where final feedback and recommendations for the protocol was received. The protocol was placed on the SANE website as a universal follow-up protocol for all SA patients. Lastly, dissemination of the project occurred through the submission of an abstract for a poster presentation at the 2016 Snowbird CME conference. Sexual assault continues to be a persistent and devastating problem in our communities. As primary care providers, it is vital to provide optimal care to SA patients to improve their health outcome and prevent/reduce medical and mental health complications. The clinical protocol and a clinic committed to caring for SA patient will deliver compassionate, quality care to patients in the Salt Lake area as they begin their path to healing.