Improving Routine Enquiry for Domestic Abuse: An ILP Quality Improvement Project

 6th March 2025

Written by James Thomas, Dinh Padicala, Abigail Winer, Clarissa Wye, Tim Hunter (QI coach), and Matt Oultram (Improvement Advisor)  

The Corporate Safeguarding Team is undergoing a quality improvement (QI) project aimed at increasing rates of Routine Enquiry into Domestic Abuse (REDA). This initiative addresses a significant gap in the Trust’s current practices, where routine enquiry for domestic abuse has not been consistently carried out, despite being a national and Trust policy. Our team are running this project alongside our participation in Wave 14 of the Improvement Leaders Programme (ILP).  

Importance of Routine Enquiry 

Routine enquiry is vital for a comprehensive understanding of patients’ needs, including hidden or sensitive issues such as domestic violence and involves tailored support and intervention. Research indicates that effective routine enquiry can significantly enhance the identification of domestic abuse, resulting in better support and outcomes for affected individuals. Several domestic homicides involving Trust patients have highlighted the urgent need for robust routine enquiry practices. 

The Driver diagram and Aim 

The primary aim of this project is to improve the identification and response to domestic abuse experienced by patients. By doing so, the Trust hopes to enhance the overall experience and safety of patients who may be facing domestic abuse. 

Our SMART aim therefore is for routine enquiry for abuse to be completed with all patients (100 per cent) at target sites by June 2025. Our target sites include Bow and Poplar ward, ADHD services (Beds) and Path to Recovery services. 

Figure 1. Driver Diagram 

Our driver diagram (figure 1) contains a number of factors we feel will help us achieve our aim. We have found the problem to be a complex one, and solutions will need to be varied according to place and service user needs.  

Testing change ideas 

We are in the process of testing a protocol to guide staff with their questions and conversations about domestic abuse. We are predicting that this will lead to improved identification, and an increase in Safeguarding referrals. We are starting with small scale tests to begin with, with small numbers of staff and patients. Our first PDSA cycle has shown promise, in that staff find the protocol useful in guiding them in asking direct questions regarding any domestic abuse. The protocol will require further testing to demonstrate whether it results in more disclosures and referrals made.   

Our measures 

Improvements will be measured by the percentage of clients being asked about domestic abuse, the number of disclosures and referrals made, staff confidence in asking REDA questions, and patient satisfaction. We have made a start with our data collection with Path to Recovery service, where we are collecting the number of patients per week with an active safeguarding case. We plan to look at data over time and examine this in our meetings, once we have enough data points to analyse. 

By testing our ideas and making improvements we aim to provide better care and support for patients experiencing domestic abuse, ultimately leading to safer and more effective healthcare services.  

Moving forward 

Overall, this project has given us an opportunity to learn deeply about a complex problem and to apply QI methods and skills we have learned from ILP to make improvements. We look forward to continuing to test change ideas over a range of services and learn as we go.