Objective People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. This study evaluated the effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department (ED). Methods This was a retrospective observational study conducted in a regional ED in Queensland. Equal time periods of 66 days before (T1), during (T2) and after (T3) the pilot service was trialled in 2013 were compared to determine changes in patient and service delivery outcomes. The time to see a doctor in the ED, ED length of stay, hospital admission rate, number of transfers from the watch house to the ED and associated costs were measured. The nature of health care delivered by nurses to detainees in the watch house during the pilot was also examined. Results Fewer detainees were transferred from the police watch house to the ED during the pilot period (T1, n=40; T2, n=29; T3, n=34). Cost reductions associated with reduced police and ambulance attendance, as well as hospitalisations, outweighed the watch house nursing costs, with cost savings estimated at AUD7800 per week (60% benefiting police; 40% benefiting the health service). The most common health problems addressed during the 1313 healthcare delivery episodes provided to 351 detainees in the watch house during the pilot related to substance misuse, chronic disease and mental health problems. Conclusion Fewer transfers from the police watch house to the ED were noted when there was a 24/7 nursing presence in the watch house. This model appears to be economically efficient, but further research is required. What is known about the topic? People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. What does this paper add? Transfers from the police watch house to the ED were fewer when there was a 24/7 nursing presence in the police watch house (an economically efficient model). Nursing care provided to detainees in the watch house setting predominantly related to substance misuse, chronic disease and mental health problems. What are the implications for practitioners? With a 24/7 nursing presence in the police watch house, transfer to the ED was avoided for some detainees. Similar strategies that respond to coronial recommendations advocating for enhancements in police-health collaboration warrant evaluation.

ED avoidance strategies including In‐Event Health Service (IEHS) processes during mass gathering events (MGEs), such as ‘Schoolies week’, may be important for EDs, ambulance services, the local population, and attendees. The aim of the present study was to provide a longitudinal description of emergency care requirements for young adults (16–18 years old); focussing on the impact of the Schoolies MGEs.

To describe and compare characteristics and outcomes of patient presentations brought in by police (BIBP) with those not BIBP (NBIBP) to one Australian ED.

Introduction:Community-based strategies designed to minimize the impact on local emergency services during mass gathering events (MGEs) require evaluation to provide evidence to inform best practice.Aim:This study aimed to describe characteristics and outcomes for people aged 16-18 years requiring emergency care before, during, and after a planned youth MGE “Schoolies week” on the Gold Coast, Australia.Methods:A retrospective observational study was undertaken. Presentations from all young adults to the emergency department (ED) or In-Event Health Service (IEHS) over a 21-day period in 2014 were included. Descriptive and inferential analyses were performed to compare across time and to describe characteristics of and outcomes for young adults requiring healthcare.Results:A total of 1029 presentations were made by youth aged 16 – 18 to the ED and IEHS over the study period (ED: 139 pre, 275 during, and 195 post; IEHS: 420 during). Patient characteristics and outcomes to the ED that varied significantly between pre, during, and post Schoolies periods included patient’s age (higher proportion of 17-year-olds), residing outside the Gold Coast region, and not waiting for treatment. All were higher during Schoolies week. Of the 24,375 MGE attendees, 420 (1.72% [95% CI, 1.57 – 1.89], 17.2/1,000) presented to the IEHS. The majority were toxicology related (n=169, 44.9%). Transportation to hospital rate was low (0.03% [95% CI, 0.01 – 0.06], 0.3/1,000) for the 24,375 MGE attendees.Discussion:Findings from this study support previous research indicating that MGEs can impact local emergency healthcare services. The provision of the IEHS may have limited this impact. The recipients of care delivery, predominantly males with trauma- or toxicology-related problems, warrants further investigation. Research describing the structures and processes of the IEHC could further inform health care delivery in and out of hospital settings.

BACKGROUND:Increasing presentations to the Emergency Department (ED) via police (which include detainees, prisoners and community residing persons) and the increase in chronic and mental health illness in detainee and prisoner populations has prompted an increased requirement for healthcare delivery within the custodial environment. This study aimed to describe the Watch House Emergency Nurse (WHEN) role, focusing on structures and processes underpinning the role.METHODS:In this qualitative, descriptive study, semi-structured interviews were undertaken in 2015 with 14 key stakeholders from health, police, and ambulance services. Interviews were analysed using content analysis to inform the findings.FINDINGS:Important structural elements of the WHEN role included an ED triage competent registered nurse, a 2-day integrated training program, and clear guidelines to provide a framework for identifying, prioritising and managing healthcare needs. Important process elements were clear communication between nurses, police, and medical staff, and a clear understanding of roles and responsibilities to facilitate continuity of care and appropriate referral. The underpinning perceived benefit of the WHEN role was 'safety'. This was in terms of personal, professional, and detainee safety.CONCLUSION:The structures and processes underpinning the innovative WHEN role provides a valuable foundation for guiding evaluations of other nursing roles in other early custody settings.

Introduction: The partnership between Health and Police services is important in preventing deaths in custody and ensuring that health care requirements for police detainees are met. Research regarding health service models of care for detainees in the police watch house setting is relatively unknown. Aim: This study aims to present the outcomes for detainees, Health and Police services when emergency nurses covered 18 hours per 24 hour period to supplement domiciliary nursing services in order to achieve a 24/7 nursing presence in the watch house over a 66 day trial period. Method: A retrospective study of the health care received by detainee/patients during the trial period (May 3–July 8 2013). Descriptive analyses will be undertaken to describe and compare patient characteristics (including reasons for care), health care received and health service outcomes for those who did and did not require transfer to the emergency department (ED) from the watch house. Results: During the trial period, 1109 nurse reviews were performed and 27 detainee/patient transfers to the ED for assessment and/or treatment were made. Outcomes in relation to the healthcare received by detainee/patients who did and did not require transport to the ED during the trial period will be presented. Conclusion: The findings in this study provide valuable information about health care delivery in the police watch house setting and the appropriate use of hospital emergency departments in relation to detainee health care.

BackgroundThe emergency department (ED) is characterised by high workload and competing demands. This study describes ED nurses perceptions of their working environment with a sub group analysis for those who also worked at the local police watch house, where individuals are detained in custody.MethodsA cross-sectional pilot study was undertaken involving a survey of nurses working in one ED in Queensland, Australia. The Working Environment Score (WES-10) consists of four subscales: Self Realisation, Workload, Conflict, and Nervousness; and is used to measure stress and staff morale. This was administered at two time periods: T1: May 2013 and T2: July 2013; before and after 10 ED nurses worked in the watch house.ResultsQuestionnaires were returned by 34 nurses at T1 and 41 nurses at T2. The perception of working environment differed between T1 and T2 for nurse respondents who worked at the local police watch house but not for nurse respondents who did not work in the watch house. Of the four sub-scales, workload was the factor that impacted most on working environment in both groups and was notably higher for those who worked in the watch house and responded at T2.ConclusionsThis pilot study identified that for ED nurses’ satisfaction with their working environment was relatively high, although certain areas (e.g., nervousness) were better than others (e.g., workload). The perception of workload was higher for T2 staff offered the opportunity to use their ED skills in a different setting, however further work with a larger sample size is required.

This study aimed to describe characteristics, outcomes, and post-emergency department (ED) departure medical requirements of patients who did not wait (DNW) or left against medical advice (LAMA) after presenting to an Australian hospital ED over a 6-month period. This was a prospective cohort follow-up study. Children and adults were compared in terms of ED characteristics and outcomes. Of the 32,333 patient presentations, 3,293 (10.2%) were recorded as DNW and 470 (1.5%) as LAMA. Of the DNW/LAMA presentations, 1,303 (34.6%) received a telephone call. One in four of the DNW/LAMA patients were children (<16 years). Most (87%) waited longer than the recommended time before leaving the ED, the majority (56%) sought care elsewhere, and some (n = 174, 13%) re-presented to the ED within 7 days; 20 of those required hospital admission. Strategies addressing front-end ED systems are required to mitigate the proportion of patients who DNW/LAMA.

BACKGROUND:The Clinical Team Coordinator (CTC) is a senior experienced nurse from the Emergency Department (ED) that provides an after-hours clinical supervision and liaison service for the entire hospital. The role guides and supports nursing and junior medical staff regarding clinical and hospital procedures, protocols and individual patient problems and assists with clinical issues on the wards such as patient assessment and management.METHOD:Following a qualitative evaluation of the CTC role in 2009, the scope of activity and impact on clinical services after hours was established through shift data collation and analysis during the calendar year 2011.RESULTS:In 2011, the CTC was directly involved with 18,165 occasions of care across the evening and night shift periods, with only one third of these calls requiring Resident Medical Officer (RMO) attention. The CTC role reviews patients, provides support and advice, facilitates impromptu education and learning, as well as assists nursing and medical staff with difficult and complex clinical tasks.CONCLUSION:Senior clinical nursing support from the CTC has been well received from nursing and medical staff and the role is now a permanently established in the hospital.

Objective To identify the prevalence, predictors and outcomes of patients who leave without being seen (LWBS) in one hospital emergency department (ED). Materials and methods A descriptive, retrospective cohort study design was used. Data were extracted from the ED Information System. Multivariate logistic regression identified independent predictors of patients who LWBS. Two main outcomes were studied: the proportion of patients who waited longer than recommended and the proportion of patients who represented to the ED within 72 h. Setting A large regional teaching hospital ED in South East Queensland, Australia. Sample A total of 64 292 patient presentations made to the ED from 9 August 2008 to 8 August 2009. Results The prevalence of patients who LWBS was 10.7%. Independent predictors of LWBS included younger age, lower urgency triage category allocation, arrival by means other than ambulance, evening and night shift presentations, winter season, weekend presentations and presenting complaint category of ‘gastrointestinal’ or ‘paediatric’. When compared with patients who waited, those who LWBS comprised higher proportions of waiting longer than recommended (LWBS: 77.2% vs. waited: 52.0%, P<0.001) and higher proportions of representations to ED within 72 h (LWBS: 10.3% vs. waited: 5.4%, P<0.001). Conclusion Outcomes investigated in this study indicate that room for improvement exists not only for patients who LWBS but all patients presenting to the ED. The most powerful predictors of LWBS were lower urgency triage allocation and evening and night shift presentations. This suggests that service improvements could be targeted during ‘out of business hours’ for those with less emergent conditions.

Gold Coast Hospital Emergency Department (ED) services a surrounding population of approximately 450,000. This figure grows on holiday periods and special events such as Indy and Schoolies to in excess of 1,000,000. The ED is small and has not been redeveloped yet. Our absolute capacity for patients needing beds is 37. This includes a 10-bed observation ward. Our presentations for the 2005/2006 year were in excess of 63,000 and this year so far is seeing a significant increase in patient numbers and acuity. In an attempt to ease the burden of increasing presentations during special events we have sent teams or nurses and doctors to both Schoolies 2006 and the Gold Coast Marathon. This presentation reviews the pre-hospital experiences we have had at these events.