When a patient arrives in the emergency department (ED) after experiencing sexual assault or strangulation, they are often in acute distress.

They may not remember everything the care team tells them. They may initially think they don’t want advocacy or access to a therapist. They may need follow-up care but — once they leave the ED — are not comfortable asking for it.

“This is a lot of trauma, and they don’t want to rehash their trauma,” said Elizabeth Gutierrez, BSN, RN, forensic nurse examiner (FNE) in the UCHealth Northern Colorado Region. “If they were able to rehash it, that would probably be more successful with somebody who already knows about the trauma.”

After reviewing 2024 regional data showing that only about 12.4% of sexual assault ED patients sought follow-up care and 4% of strangulation ED patients followed up with their primary care provider for care, Gutierrez championed a program for the nurses to follow up.

The outpatient FNE follow-up clinic launched this spring to see patients who have experienced violence — such as intimate partner violence, physical assaults and sexual assaults — at two freestanding EDs (FSED): UCHealth Emergency Room – Harmony Campus and UCHealth Emergency Room – West Greeley.

A few days after an FNE sees a patient at an ED, the team contacts the patient and offers to meet them for an outpatient appointment at one of the FSEDs. The two locations were chosen as options because they tend to have lower volumes than the hospital-based EDs, but they still have security at the entrance. The settings also may be less overwhelming to the patient than returning to the same ED where they were previously seen.

Gutierrez said the FNEs are cautious when reaching out to the patients, who may be facing dangerous domestic situations. The FSEDs are open 24/7, and there is flexibility to have the outpatient visit when it is most convenient to the patient — even if it’s late at night.

“Whatever is best for them. We want them to gain some self-worth and independence back,” Gutierrez said. “Gain that control back, because they’ve lost a lot of control from this assault.”

If the patient doesn’t have transportation, the FNEs are able to coordinate with advocates who can help them get to appointments as well as navigate support available in the community.

At the appointment, the FNEs can:

• Connect them with an advocate and/or access to a safehouse.
• Help with retesting for sexually transmitted infection and pregnancy.
• Obtain updated photos of injuries.
• Help coordinate referrals; for example, if a patient has been strangled, there’s potential they are having symptoms of mild traumatic brain injury and need to see a neurologic physical therapist.
• Help them connect with a primary care provider to receive ongoing care.

The clinic saw its first patient in March and continues to grow. Eventually, Gutierrez anticipates extending it to additional locations.

 

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