Clinical risk for substance-affected patients attending an emergency department in the Northern Territory with police

A quality improvement initiative

Sandra J. Brownlea, Justine Miller, Jessica Meagher, Federica Barzi, Didier Palmer

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: 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.

    Methods: 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.

    Results: 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).

    Conclusion: 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.

    Original languageEnglish
    Pages (from-to)1-7
    Number of pages7
    JournalEMA - Emergency Medicine Australasia
    DOIs
    Publication statusE-pub ahead of print - 28 Mar 2019

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    Northern Territory
    Police
    Quality Improvement
    Hospital Emergency Service
    Homeless Persons
    Alcoholism
    Comorbidity
    Social Determinants of Health
    Case Management
    Chronic Disease
    Cohort Studies
    Retrospective Studies
    Odds Ratio
    Alcohols
    Demography
    Confidence Intervals

    Cite this

    @article{d56746c545bb4263b79bea3b42848339,
    title = "Clinical risk for substance-affected patients attending an emergency department in the Northern Territory with police: A quality improvement initiative",
    abstract = "Objective: 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. Methods: 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. Results: 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). Conclusion: 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.",
    keywords = "alcohol dependence, did not wait, frequent attender, homelessness, police arrival, vulnerable patient",
    author = "Brownlea, {Sandra J.} and Justine Miller and Jessica Meagher and Federica Barzi and Didier Palmer",
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    Clinical risk for substance-affected patients attending an emergency department in the Northern Territory with police : A quality improvement initiative. / Brownlea, Sandra J.; Miller, Justine; Meagher, Jessica; Barzi, Federica; Palmer, Didier.

    In: EMA - Emergency Medicine Australasia, 28.03.2019, p. 1-7.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Clinical risk for substance-affected patients attending an emergency department in the Northern Territory with police

    T2 - A quality improvement initiative

    AU - Brownlea, Sandra J.

    AU - Miller, Justine

    AU - Meagher, Jessica

    AU - Barzi, Federica

    AU - Palmer, Didier

    PY - 2019/3/28

    Y1 - 2019/3/28

    N2 - Objective: 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. Methods: 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. Results: 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). Conclusion: 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.

    AB - Objective: 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. Methods: 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. Results: 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). Conclusion: 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.

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    KW - did not wait

    KW - frequent attender

    KW - homelessness

    KW - police arrival

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    DO - 10.1111/1742-6723.13273

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