St Vincents Hospital, Australia
Scientific Tracks Abstracts: Emerg Med
The Emergency Department, St Vincent‚??s Hospital, Sydney is unique regarding the number of disadvantaged, homeless, mental health and drug and alcohol patients that it manages. St Vincent‚??s now supports the highest concentration of homeless persons in Australia, with its inner-city location also attracting a high proportion of persons with mental health illness and regular drug and alcohol users. Use of the psycho-stimulant methamphetamine ‚??Ice‚?Ě use is a particular and difficult problem. At present, data suggests around 15.0 % of the patient presentations to our Emergency Department (ED) involve mental illness and/or the effects of drug use. Of these patients, many will require the input of our mental health team during their stay. Under NSW law, patients arriving under the Mental Health Act or placed under the act after arrival must be reviewed by a psychiatrist. To perform a valid assessment, the patient must be free from the influence of any drugs or illness that might affect their mental state at the time of review. Often patients presenting in acute mental health crisis have co-existent medical problems which require concurrent management. The patient must be managed medically in a safe setting until medically fit for mental health review. Depending on the nature and effects of an influencing substance or illness, this may take hours, even days. We have estimated that there are on average, between 2 and 10 patients (median=4) who fall into this category, presenting at St Vincent‚??s Hospital Emergency Department each day. We have created a novel 6 bed ward, near our current Emergency Department, to which suitable patients can be admitted, for safe observation, management and nursing. The PANDA model is a 7 day a week, 24 hour a day service, managed by the clinical pharmacology and drug and alcohol teams in close collaboration with the Emergency Department and the Mental Health Service. Voluntary or involuntary patients who meet the inclusion criteria can be admitted to the PANDA. This presentation outlines the difficult problems for this subgroup of patients, the current treatment options and a novel new model of care.
Paul Preisz has completed his MBBS and is working as a Senior Staff Specialist at St Vincent’s Hospital Darlinghurst, Senior Lecturer Emergency Medicine, UNSW, Associate Professor and a Discipline Head at University Notre Dame. He is an Emergency Physician and is the current Acting Director of the Emergency Department, St Vincent’s Hospital, Darlinghurst in Sydney, Australia. He has a long-term interest and expertise in the care of emergency patients presenting with mental health and medical co-morbidities. He has published and lectured widely on the clinical management of toxicological poisoning and over dosage emergencies, the acute care of drug induced psychosis and sedation of the agitated and behaviorally disturbed patient.
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