Delivering emergency care in the watch house: an outcomes analysis.

Grant ID: EMPJ-305R23-2015

Project Summary

Increasingly, prisoners are requiring transfer to and assessment in the ED; some for illnesses that may be treated in the custodial environment with an appropriately trained health care professional. Optimising how health care is delivered in the watch house environment was the focus of this study, following recommendations in a recent (2012) Inquiry following the death of Herbert John Mitchell.

This study is underpinned by recommendations from deaths in custody, the literature and anecdotal experience. The study will provide a comprehensive outcomes evaluation of a 66 day trial of a model where emergency nurses were posted to the local watch house for an 8hr late shift and a 10hr night shift to supplement domiciliary nursing services to provide 24hr nursing presence in the watch house. This model of enabling experienced emergency nurses the opportunity to work within an 'out of hospital environment' but with the support from medical colleagues has not to our knowledge been trialed elsewhere and is therefore innovative.

The impact expected from this study is on the prisoners, health care staff and police staff working in this model. We expect the following main outcomes: less transfers of prisoners to ED from the watch house and a cost effective model.

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Outcomes

During the six-month evaluation period, there were 35,127 emergency department presentations. Of these, 392 (1.1%) were patients brought to the hospital by police from the watch house; they are more likely to have mental health and drug and alcohol issues than other patients.

Pending publication on evaluation of the Watch-house Emergency Nurse (WHEN) healthcare delivery model.

> Research Award winner at the Bond University Sustainable Healthcare Awards 2018

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IMPACT

The Gold Coast University Hospital and the Southport Watch-House continue to operate the Watch-house Emergency Nurse (WHEN) healthcare delivery model (adopted in 2013), albeit in a slightly different structure. Other sites in Queensland are interested in this model of care.

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Leveraged Funds

- $9,300: Gold Coast Hospital Foundation
- $20,000: In-kind funding

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Dissemination

Journals
- Crilly J., Zhang P., Lincoln C., Scuffham P., Timms J., Becker K., van Buuren N., Fisher A., Murphy D., Green D., “Characteristics and outcomes of patient presentations made by police to an Australian emergency department”, Emerg Med Australas, 2019 May 6. doi: 10.1111/1742-6723.13301. [Epub ahead of print]
- Crilly J., Johnston A.N., Wallis M., Polong-Brown J.m Heffernan E., Fitzgerald G., Young J.T., Kinner S., “Review article: Clinical characteristics and outcomes of patient presentations to the emergency department via police: A scoping review”, Emerg Med Australas, 2019 May 21. doi: 10.1111/1742-6723.13300. [Epub ahead of print]

Conferences

- Crilly J, Lincoln C, Scuffham P, Timms J, Becker K, van Buuren N, Fisher A, Murphy D, Green D. Providing 24/7 nursing presence in the police watch house: what’s the impact on the emergency department?", 2nd Global Conference on Emergency Nursing & Trauma Care. September 2016, Sitges, Spain.

- Lincoln C, Crilly J, Scuffham P, Timms J, Becker K, van Buuren N, Fisher A, Murphy D, Green D., "Reducing risks and improving health outcomes for detainees in watch houses: do emergency department nurses in the custodial setting make a difference?", Pathology Update 2016, February 2016, Melbourne (invited speaker)

- Crilly J, Lincoln C, Scuffham P, Timms J, Becker K, van Buuren N, Fisher A, Murphy D, Green D., "Care delivery for patients arriving to the emergency department by police", Applied Research in Crime and Justice Conference 2016, February 2016, Brisbane (poster)

- Crilly J, Lincoln C, Scuffham P, Timms J, Becker K, van Buuren N, Fisher A, Murphy D, Green D., "Characteristics and outcomes of patient presentations made to a Queensland emergency department by Police", 32nd Annual Scientific Meeting of the Australasian College for Emergency Medicine, November 2015, Brisbane

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