Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/11274
Title: Clinical risk for substance-affected patients attending an emergency department in the Northern Territory with police: A quality improvement initiative.
Authors: Brownlea, Sandra J
Miller, Justine
Meagher, Jessica
Barzi, Federica
Palmer, Didier
Affiliation: Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia..
Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia..
Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia..
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia..
Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia..
Issue Date: 28-Mar-2019
Citation: Emergency medicine Australasia : EMA 2019-03-28
Abstract: Determine clinical risk for patients presenting to Royal Darwin Hospital ED when they cannot be cared for at the police watch-house (WH) or sobering-up-shelter (SUS) because of a medical concern. This is a retrospective cohort study of police arrivals from May to July 2016. Data collection included demographics and presumed cause of intoxication. Outcomes used as markers of risk were departure status, return visit within 24 h and frequency of ED attendance over 3 months. Social determinants of poor health were collected for the June cohort. There were 247 attendances with police by 170 patients. Most were alcohol affected (monthly rates between 83% and 92%). The 'did not wait/left at own risk' rate was high (41-44% vs 7.7%; P < 0.001) and hospital admission rates low (2-7% vs 29%; P < 0.001). Rates of representation (20% within 24 h), ED attendance (≥73% had a further visit within 3 months), comorbidities (46% with three or more chronic diseases), homelessness (66%) and alcohol dependence (85%) were high. Patients presenting more than five times over 3 months were less likely to wait (odds ratio 2.4, 95% confidence interval 1.1-5.2, P = 0.03). This is a common presentation at Royal Darwin Hospital ED by a patient group with high levels of comorbidity, homelessness and alcohol dependence. Nearly half self-discharged prior to medical assessment. These patients frequently re-attend the same facilities and enter into a cycle of non-intervention. Case management across services is needed to improve the opportunity that these patients receive appropriate medical, social and addiction interventions.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/11274
DOI: 10.1111/1742-6723.13273
ORCID: https://orcid.org/0000-0001-5267-972X
Type: Journal Article
Subjects: alcohol dependence
did not wait
frequent attender
homelessness
police arrival
vulnerable patient
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