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At a Glance

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: < 24hrs

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 mental health/AOD problems without acute comorbid medical issues.
  • Patients presenting with complex psychosocial needs, or in situational crisis.
  • Patients scoring 0 on the BOC Chart.
  • Patients with acute mental health and/or AOD issues who have been assessed as not needing any acute emergency care and not being at risk of agitation or aggression (i.e. are low risk (versus medium or high) according to mental health risk assessment).
  • Patients with suicidal ideation who have been assessed as not being at immediate risk (i.e. lacking a plan and intent for immediate suicide or self-harm).

Exclusion Criteria

  • Patients presenting with acute psychotic symptoms (e.g. patients presenting with command or derogatory hallucinations).
  • Patients presenting with acute agitation (e.g. agitation due to complex behaviour/psychosis/delirium/acute intoxication/acute withdrawal, intellectual impairment or acquired brain injury (ABI)).
  • Patients presenting with altered sensorium.
  • 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.

Clinical Care

All Areas

  • Provide care to low-risk patients with high-prevalence mental health, alcohol and other drugs and social care needs
  • 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

Cubicles

  • 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
    • 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.

Interview Rooms

  • May be used with The Hub patients for bed-admitted activity
  • May be used with families/support persons of The Hub patients

Important: all clinical interventions and assessments should occur in the interview rooms of The Hub – the bedroom spaces should be left as private space for the patient.

All clinicians should liaise with the nurse looking after the patient if they need to provide clinical care in one of the interview rooms, asking the nurse to engage with patient and explain the activity that is to occur.

Emergency Management & Escalation

Emergency Equipment

  • Resus Trolley located in Adult Fast Track
  • Bedside emergency roll down equipment in BARs and BAU cubicles

Escalation Process (as per current ED processes)

  • FT ANUM (AM/PM) – Floor Coordinator (ND) / Medical officer in Charge
  • 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

  • FT ANUM (AM/PM) – Floor Coordinator (ND)
  • 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

Staffing

Nursing

  • 1 BAU and The Hub NIC (working across both areas)
  • 2 The Hub Nurses (ratio 1:4)
  • 1 MH Nurse Navigator (working across ED)

Medical

  • Medical staffing shared with Adult Fast Track
  • 1 ED Registrar (ND only)

ACE

  • 2 ACE Coordinators (AM/PM only)
  • 1 Late (ND only)

EMH (working across ED)

  • 4 EMH Clinicians AM & PM (3 during ND shift)
  • 1 Psychiatry Registrar
  • 1 Consultant Psychiatrist (AM/PM only)

AOD

  • 1 AOD Clinicians (2 during AM and PM shifts)
  • 1 AOD Registrar (Seven Days per week)

Pharmacy

1 ED Pharmacist (working across ED)

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