After an intimate partner violence (IPV) disclosure, the next task is not simply to ask whether the patient plans to leave. It is to find out whether danger is immediate, whether an injury needs urgent care, and what safety step the patient can take without increasing risk. Four risk markers help focus that conversation—but a checklist cannot make the disposition decision for you.
Ask four behavior-specific questions
Ask privately, in plain language, and give the patient time to answer. If they use a word like “choked,” clarify what happened rather than relying on a clinical label. Ask when each event occurred and what has changed recently.
| Risk marker | Ask directly | Why it matters |
|---|---|---|
| Access to weapons | “Does your partner have access to a firearm or another weapon? Have they shown, used, or threatened you with one?” | Access and weapon threats have been associated with femicide risk. Ask about access, not only ownership. |
| Escalating violence | “Has the violence become more frequent or severe? Are the injuries worse, or has it changed from threats to physical violence?” | A worsening pattern may signal increased danger. Do not assume every relationship follows a predictable cycle. |
| Threats of lethal harm | “Has your partner threatened to kill you or your children? Have they threatened suicide?” | Threats to kill the patient or children are concerning risk markers. A partner’s suicide threat is a separate safety concern: clarify its immediacy and do not dismiss it as a bluff. |
| Prior strangulation | “Has your partner ever put pressure on your neck, stopped you from breathing, or made you lose consciousness?” | People may describe this as choking. Prior nonfatal strangulation has been associated with increased odds of attempted or completed homicide among women in case-control research, and it can also cause serious injury. |
These are risk markers, not diagnostic criteria or a complete lethality assessment. Research links several factors—including weapon access, weapon threats, and prior nonfatal strangulation—to lethal or near-lethal violence, but none predicts exactly what will happen to one person. Much of the foundational research studied women abused by male partners; the findings should not be treated as a precise forecast for every patient or relationship.
A red flag changes the assessment—not automatically the disposition
A “yes” is a reason to ask more, not a score that by itself dictates police involvement, hospital admission, or separation. Ask whether the partner is nearby or waiting outside, whether the patient feels safe returning home, whether a threat is active now, and whether the patient has a safe way to leave the clinic. Ask about children or other dependents who may also be at risk.
Timing matters. A past threat and an immediate threat are not the same clinical situation, although both deserve attention. Ask what happened most recently, whether the patient has tried to leave or is planning to, and whether stalking, coercive control, or a recent change in the relationship adds to their concern. A structured tool such as the Danger Assessment-5 (DA-5) may help organize a fuller assessment when appropriate, but it is not a precise forecast or an all-clear when the patient describes danger or the clinician remains concerned.
If there is an immediate threat—for example, the partner is outside, has made a specific near-term threat, or the patient says they cannot safely return—pause routine discharge planning. Keep the conversation private, explain available options, and work with the patient on a safe next step. Depending on the situation, that may include an IPV advocate, emergency medical care, clinic security, or emergency services. Involve law enforcement in keeping with the patient’s wishes where possible and applicable legal requirements; do not treat it as the automatic response to every disclosure.
Treat strangulation as both a safety and medical concern
A history of strangulation matters even if the event was described as “choking” and there are no visible marks. External appearance alone does not reliably establish that no injury occurred. Ask when it happened and whether there was loss of consciousness, confusion, trouble breathing or swallowing, voice change, neck pain, or new neurologic symptoms.
Arrange timely medical assessment after a recent neck-compression event. Breathing difficulty, voice change, trouble swallowing, loss of consciousness or confusion, and new neurologic symptoms warrant emergency-level evaluation. The event may raise concern about future violence and may also require assessment for injury from the neck compression.
Make the safety plan safe to receive
If danger is not immediate, a same-day connection to a trained IPV advocate can help the patient consider options without being pressured to leave. Ask what would make the next hours or days safer: a safe place to go, transportation, a trusted person, access to medications or documents, or a plan for children. The patient’s priorities and knowledge of the partner’s behavior should shape the plan. Leaving can increase danger in some situations, so avoid telling the patient to leave immediately or asking why they have not left.
Check how the patient can safely receive follow-up. A shared phone, voicemail, patient portal, printed handout, or item placed in a bag may be monitored or discovered. Ask what contact method is safe before sending anything; offer a private clinic phone for connecting with an advocate when available. Explain confidentiality and its limits, and check local law and clinic policy before making assumptions about reporting obligations. Document the patient’s words and the plan factually, and arrange follow-up through the agreed safe channel.
Practical takeaways
- Ask about weapon access, escalation, threats to kill, and prior strangulation.
- Clarify timing, current access, and the patient’s own sense of immediate danger; four questions are not a complete lethality assessment.
- Treat recent strangulation with breathing, voice, swallowing, consciousness, or neurologic symptoms as an urgent medical issue—even without obvious marks.
- Match the response to the patient’s circumstances: offer advocacy and a collaborative safety plan, rather than assuming one action fits every disclosure.
- Confirm that follow-up and resource information can reach the patient safely.
