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Admission/Entry

  • Admit via Emergency Services Arrival or Walk in Triage
  • Transfer from another ED clinical area

Hours of Operation & Length of Stay

  • Open 24/7 – 365 days a year
  • LOS (BAR): ≤ 0.5hrs
  • LOS (BAU Cubicle): < 24hrs
  • LOS (BAU Interview Room): ≤ 1hr

Inclusion Criteria

Inclusion Criteria

  • Patients 18 to 64 years old, unless an exemption is granted by an ED consultant, or the Senior Medical Officer in Charge (SMOIC).
  • Patients presenting with increased distress either due to severity of psychotic symptoms (delusion(s) and/or hallucinations), and/or severe depressive symptoms (e.g. anhedonia).
  • Patients presenting with acute agitation (e.g. agitation due to complex behaviour/psychosis/delirium/intoxication/acute withdrawal, intellectual impairment or acquired brain injury (ABI)).
  • Patients presenting post or at risk of an episode of serious self-harm or harm to others, suicidal ideation or behaviour.
  • Patients presenting post suicide attempt or experiencing acute suicidal ideation.
  • Existing mental health/AOD patients who present requiring intervention to prevent or contain relapse. This is subject to the clinical judgement of medical staff.
  • Patients under police escort under the Mental Health Act 2014 (s351).
  • Patients scoring ≥1 on the Behaviours of Concern (BOC) Chart (indicating risk of high agitation and/or violence may be present).
  • Patients for whom restraint is or may be required

Exclusion Criteria

  • Patients who need assessment and management of an acute medical health issue (noting it is the clinical decision of the ED Medical Officer/Consultant in-charge to determine if a treatment space is fit-for-purpose where medical care is required)

Clinical Care

All Areas

  • Manage and assist patients that present at high risk of self-harm or causing harm to others, including highly agitated and/or aggressive patients
  • Follow an integrated, multidisciplinary and holistic care approach achieved by collaboration between emergency medicine and nursing, mental health staff, and AOD and ACE clinicians in the ED setting
  • Provide a low stimuli environment with increased privacy to facilitate appropriate clinical and therapeutic interventions for patients
  • Facilitate appropriate and timely admission to inpatient services or referral to community-based services
  • Work in accordance with the Chief Psychiatrist’s guideline – Restrictive interventions in designated mental health services
  • As a Low Risk COVID-19 zone, High Risk patients need to be de-isolated (e.g. via RAPID swab in a BAR) before they can be admitted to a BAU cubicle

Behaviour Assessment Room (BAR)

  • Assessment & stabilisation of patients with Behaviours of Concern (BOC)
  • Where clinically indicated, application of physical, mechanical and/or chemical restraint
  • Nursing & medical assessment
  • Assessment & early treatment for patients in the wait room
  • Management of an (un)differentiated patient presenting to ED in behavioural and/or mental health crisis
  • Coordinating the management of complex patients, including organising appropriate referral
  • Search of a patient
  • Streaming to most appropriate clinical area
  • Where appropriate, initial patient triage; use of ATS (Australasian Triage Scale)

BAU Cubicle

  • Medical, psychiatric and AOD intervention for identified patient care needs, including:
    • Patient-centred nursing care, including appropriate patient engagement.
    • Mental health/AOD/ACE team assessment and – where clinically indicated – brief, focused therapeutic interventions based on evidence-based and trauma-informed practice.
    • Verbal de-escalation and management of BOC
    • Where clinically indicated, continuation of physical, mechanical and/or chemical restraint
    • Pharmacotherapy and review and/or commencement of medications by ED medicine.
    • Psycho-social support, such as goal-setting.
    • Patient, family and carer-targeted harm-reduction and education-based intervention.
    • Patient-centred and recovery-focused treatment planning, discharge planning and best pathway referral.

BAU Interview Room

  • May be used for patients who are medically stable and have a BOC score ≤ 1, for BAU bed-admitted activity or for patients requiring further assessment to determine best pathway.

Contact the Nursing Team Lead or EMH for assessment to help determine the best pathway

Emergency Management & Escalation

Emergency Equipment

  • Resus Trolley located in staff station
  • Bedside emergency roll down equipment in BARs and BAU cubicles

Escalation Process (as per current ED processes)

  • NIC / Consultant
  • DOS huddle
  • RiskMan
  • Code grey/planned code grey
  • Duress

Emergency Response

  • Transfer to Resuscitation area as required
  • Code Blue and MET call if additional assistance is required

Medical Emergency Response

  • ED NIC
  • Resuscitation Nurse 1
  • Bedside nurse
  • Resuscitation Registrar
  • Mental Health Nurse Navigator
  • MH/Resus ANUM

Lockdown

  • Pager to security & ED NIC/ANUM
  • Panel in Adult Triage and Security Office

Security Response

  • Code Black/Code Grey/BOC call

BOC Call Response

  • Treating medical & nursing team
  • Security
  • EMH Clinician
  • Staff in area planned to receive patient

Staff Safety

  • Code grey/BOC Call: planned/unplanned
  • Fixed duress
  • Personal duress

Disposition

  • Assess and discharge from BAR – stream to appropriate clinical area
  • Inpatient admission
    • Inpatient Mental Health Unit
    • specialist AOD service
  • Medical admission
    • other ED clinical area or SSU
    • transfer to another hospital/facility
  • May use the discharge lounge (Non COVID) in hours
  • Discharge home with post-treatment planning that will accommodate patient follow-up needs, including linkages with 24/7 state-wide support services (e.g. Direct Line), and appointments with local services

Discharge Process

  • Script
  • Outpatient follow up
  • Certificate
  • Referrals
  • Discharge Letter/Summary

Staffing

TBC