Effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department
Julia Crilly A B J , Cathy Lincoln C , Paul Scuffham A B , Josh Byrnes A D , Jo Timms B , Ken Becker E , Nelle van Buuren C , Andrew Fisher B , Danny Murphy F , Ping Zhang A B , Stuart Kinner G H I and David Green BA Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Qld 4222, Australia. Email: p.scuffham@griffith.edu.au; p.zhang@griffith.edu.au
B Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, 1 Hospital Blvd, Southport, Qld 4215, Australia. Email: Jo.Timms@health.qld.gov.au; Andrew.Fisher@health.qld.gov.au; David.Green@health.qld.gov.au
C Gold Coast Forensic Medicine, Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, Qld 4215, Australia. Email: Cathy.Lincoln@health.qld.gov.au; Nelle.VanBuuren@health.qld.gov.au
D Centre for Applied Health Economics, School of Medicine, Griffith University, 170 Kessels Rd, Nathan, Qld 4111, Australia. Email: j.byrnes@griffith.edu.au
E Southport Watch House, Queensland Police Service, 96 Scarbrough St, Southport, Qld 4215, Australia. Email: Becker.KenD@police.qld.gov.au
F State LASN Operations, Emergency Management Unit, Queensland Ambulance Service, 497 Bilsen Rd, Geebung, Qld 4034, Australia. Email: danny.murphy@ambulance.qld.gov.au
G Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, Vic. 3010, Australia. Email: s.kinner@unimelb.edu.au
H Centre for Adolescent Health, Murdoch Children’s Research Institute, Flemington Rd, Parkville, Vic. 3052, Australia.
I Griffith Criminology Institute, Griffith University, 176 Messines Ridge Rd, Mt Gravatt, Qld 4122, Australia.
J Corresponding author. Email: julia.crilly@health.qld.gov.au
Australian Health Review 44(6) 924-930 https://doi.org/10.1071/AH19294
Submitted: 8 January 2020 Accepted: 3 May 2020 Published: 12 October 2020
Abstract
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.
Keywords: ambulance, emergency department, evidence, health economics, model of care, outcomes, police.
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