Clinically Speaking

Every 98 seconds, someone in the US experiences sexual assault. Although the national incidence of assault has gone down, only 6 in 1000 perpetrators will spend time in prison. 

Providers at University of Colorado Hospital want this to change and are working to reduce the trauma associated with gathering clinical evidence.

After surviving an assault, a person can undergo a Sexual Assault Nurse Examiner (SANE) forensic exam. Christine Foote-Lucero, BSN, RN, CEN, SANE-A, SANE-P, is the forensic program manager at UCH. She explains that their forensic suite offers patients and providers a safe, comfortable space where they can be assured DNA evidence will not be compromised. In addition, the medical forensic exam offers a thorough exam to assess the patient’s health and well-being, connect the patient to critical resources and referrals, and document injuries via forensic photography. (Pictured above, l-r, Christine Foote-Lucero and Sarah Selby)

“Very few programs have a dedicated private suite for these sensitive exams,” she said. “In the main emergency department you may have multiple providers coming in and out of the room. This means multiple sources of DNA—you can spread your DNA by up to three feet just by talking. Here the suite is cleaned thoroughly between each patient to really give our patients the best chance possible for uncontaminated samples.” 

The suite has also been designed to be as warm and non-threatening as possible. Foote-Lucero explains that the team worked hard to make it inviting rather than sterile and clinical. 

“The intake room where patients first come in is carpeted and has soft lighting. It’s a welcoming space where we can talk to the patient and establish a rapport,” she said. “Our examination room has all the necessary clinical equipment but also warm, neutral décor, quotes to inspire our patients and a large, private bathroom and shower. We can provide a new set of clothes if necessary, and offer a hygiene kit with good quality shampoo, deodorant and other essentials.”

As one of the few locations with such a purpose-built space, the team at UCH has received some powerful reactions from patients.

“The very first patient I saw in this exam room cried and I assumed she was crying from the trauma,” Foote-Lucero said. “I asked if I could get her some tissues and she said she was crying because of this beautiful space. It stuck with me. She said she had supported friends at other places and never seen anything like this before.” 

Providing vital services for patients in need

The forensic nursing program at UCH currently sees approximately 25 patients a month, and cares for patients affected by a variety of crimes in addition to sexual assault, such as human trafficking, elder abuse, strangulation and intimate partner violence. UCH became a 24/7, on-call forensic team in November 2017.

“It’s really important to have someone there at all times,” said Foote-Lucero. “The literature tells us that when these patients are transferred between hospitals, they might be so exhausted and overwhelmed they refuse an exam and just want to go home after leaving the ED.”

A medical forensic exam can take 3-5 hours to complete, so the new forensic suite plays an important role in providing vital one-on-one care for patients while relieving the burden on the emergency department.

Forensic nurses also receive courtroom training so they can testify if necessary. Cases that feature medical forensic exams conducted by trained forensic nurses achieve a higher conviction rate, with 28% more patient injuries identified compared to exams conducted by nurses without the forensic nursing education and training. This statistic is helped by the fact that the forensic suite has a colposcope—the gold standard in equipment to assess injury caused by sexual assault -- a binocular microscope to identify even the most minute injuries. 

What does it take to become a SANE?

Sarah Selby, DO, is medical director of the forensic nursing program at UCH. She explains that nurses undergo extensive training to become forensic nurses.

“The average orientation for a new forensic nurse takes about 6–9 months,” she said. “They have to complete a 60-hour online course and have 300 clinical hours before they can sit for board certification. They also take six precepted adult exams and six pediatric exams, demonstrate speculum proficiency and undertake 24 hours of courtroom training.” 

Such dedication naturally requires a big financial commitment for UCH, something Dr. Selby is working to remedy.

“We’re applying for a grant so we can provide specialty SANE training. With that, we’ll be able to increase the number of nurses with this certification, provide evidence-based feedback and offer more training to continue to grow our program and other programs throughout the state. We’re hoping to open the training to anyone in Colorado and surrounding states such as Nebraska and Wyoming.”

Spreading the word to make a difference

“The highly trained staff of the SANE program offer a critical community service for the survivors of sexual violence and trafficking,” said Jennifer Wiler, MD, MBA, FACEP, executive vice-chair and professor in the Department of Emergency Medicine.

That’s why it’s so important that they raise awareness of the forensic nursing program. So far they’ve held an open house where they invited community partners, local law enforcement, victim advocates and news organizations. 

“We’re just trying to get the word out so we can help wherever there is need,” said Dr. Selby. “At some point we’d also like to hold an open house for everyone on campus. Although a good proportion of our patients present to the ED, anyone on campus can request a medical forensic exam if they feel they have a potential forensic patient.”

Foote-Lucero is aiming for the same goal, and explains the team is working on a process to enable freestanding emergency departments to transfer patients to the forensic suite.

“There is a great deal of need out there,” she said. “We’re doing what we can to make the worst day of someone’s life the best it can be.”