Navigating Law Enforcement Presence in Emergency Departments.

Importance: Law enforcement presence is widespread in emergency departments (EDs), but unregulated law enforcement exposure can be associated with poor health outcomes for survivors of violence (SOVs). Current literature has not explored the effective management of law enforcement presence in emergency medical settings that would support SOVs while allowing the priorities of other ED stakeholders (clinicians, staff, and law enforcement) to be met. Objective: To identify mutually beneficial strategies to manage and mitigate the unintended harms associated with law enforcement presence in the ED. Design, Setting, and Participants: This qualitative study was conducted between September 2020 and September 2023 in an urban level I trauma center. Trained researchers conducted semistructured interviews with hospital-based violence intervention program (HVIP) representatives and SOVs as well as focus groups with law enforcement officers (LEOs). Eligible participants included SOVs (survivors and affected family members), HVIP representatives (staff and clinicians) who had interacted with law enforcement in the ED, and LEOs (patrol officers, detectives, and captains) who had directly interacted with SOVs in the ED. Data analysis was conducted between July 2022 and October 2023. Main Outcomes and Measures: Multistakeholder perspectives on their experiences, needs, and priorities in the ED and recommendations for potential effective strategies to manage law enforcement in the ED. Mixed interviews and focus groups were used to tailor methods to the stakeholder groups and triangulate across stakeholders. A qualitative thematic analysis was used to synthesize data and develop themes. Transcripts were coded using codebooks, which were developed using study protocols and iteratively revised after rounds of independent coding. Results: In this study, 21 SOVs and 23 HVIP representatives were interviewed, and 16 LEOs participated in focus groups. Stakeholder consensus emerged on 3 main themes: triaging interactions with law enforcement, formalizing hospital staff and law enforcement training, and integrating SOV advocates in the ED. Conclusions and Relevance: This qualitative study identified 3 strategies, informed by the perspectives of multiple stakeholders, to manage law enforcement presence in the ED. Optimization of hospital environments through these 3 strategies may support SOV rights and recovery, mitigate adverse interactions between law enforcement and SOVs, and improve information sharing and job effectiveness for different stakeholders in the ED.