This study analysed the processes currently used to identify and respond to domestic and family violence in a large tertiary hospital in Australia, and identified the benefits and weaknesses of the existing systems. There was a dearth of existing guidelines or pathways of care for patients experiencing domestic violence. Several weaknesses were identiﬁed in relation to the protocols and systems used by the hospital, including limited training for staff, and a lack of standardisation of processes, workplace instructions and clinical guidelines. Except for maternity services, no clinical service area used a guideline or work instruction. Most interviewees highlighted the need to prioritise the safety and protection of staff and victims.