{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T22:22:14Z","timestamp":1762899734870,"version":"3.40.5"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T00:00:00Z","timestamp":1553731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Determine clinical risk for patients presenting to Royal Darwin Hospital ED when they cannot be cared for at the police watch\u2010house (WH) or sobering\u2010up\u2010shelter (SUS) because of a medical concern.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective cohort study of police arrivals from May to July 2016. Data collection included demographics and presumed cause of intoxication. Outcomes used as markers of risk were departure status, return visit within 24\u2009h and frequency of ED attendance over 3 months. Social determinants of poor health were collected for the June cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 247 attendances with police by 170 patients. Most were alcohol affected (monthly rates between 83% and 92%). The \u2018did not wait\/left at own risk\u2019 rate was high (41\u201344% <jats:italic>vs<\/jats:italic> 7.7%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and hospital admission rates low (2\u20137% <jats:italic>vs<\/jats:italic> 29%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Rates of representation (20% within 24\u2009h), ED attendance (\u226573% had a further visit within 3 months), comorbidities (46% with three or more chronic diseases), homelessness (66%) and alcohol dependence (85%) were high. Patients presenting more than five times over 3\u2009months were less likely to wait (odds ratio 2.4, 95% confidence interval 1.1\u20135.2, <jats:italic>P<\/jats:italic> = 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is a common presentation at Royal Darwin Hospital ED by a patient group with high levels of comorbidity, homelessness and alcohol dependence. Nearly half self\u2010discharged prior to medical assessment. These patients frequently re\u2010attend the same facilities and enter into a cycle of non\u2010intervention. Case management across services is needed to improve the opportunity that these patients receive appropriate medical, social and addiction interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.13273","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T04:20:14Z","timestamp":1553833214000},"page":"948-954","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical risk for substance\u2010affected patients attending an emergency department in the Northern Territory with police: A quality improvement initiative"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5267-972X","authenticated-orcid":false,"given":"Sandra J","family":"Brownlea","sequence":"first","affiliation":[{"name":"Emergency Department Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Miller","sequence":"additional","affiliation":[{"name":"Emergency Department Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Meagher","sequence":"additional","affiliation":[{"name":"Emergency Department Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Barzi","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Charles Darwin University  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didier","family":"Palmer","sequence":"additional","affiliation":[{"name":"Emergency Department Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2010.tb03905.x"},{"key":"e_1_2_7_3_1","unstructured":"Northern Territory Legislation.Northern Territory of Australia Police Administration Act Section 127A. Northern Territory Government 2018. [Cited 15 Jan 2019.] Available from URL:https:\/\/legislation.nt.gov.au\/en\/Legislation\/POLICE\u2010ADMINISTRATION\u2010ACT"},{"key":"e_1_2_7_4_1","unstructured":"PricewaterhouseCoopers Indigenous Consulting Pty Ltd with Menzies School of Health Research.Evaluation of the Alcohol Mandatory Treatment Program. Northern Territory Department of Health 2017. [Cited 3 Mar 2019.] Available from URL:http:\/\/digitallibrary.health.nt.gov.au\/prodjspui\/bitstream\/10137\/1226\/1\/Alcohol%20Mandatory%20Treatment%20Evaluation%20Report.pdf"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja15.00858"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.11124\/jbisrir-2015-2203"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.02.018"},{"key":"e_1_2_7_8_1","unstructured":"Northern Territory Legislation.Northern Territory of Australia Volatile Substance Abuse Prevention Act. Northern Territory Government 2018. [Cited 15 Jan 2019.] Available from URL:https:\/\/legislation.nt.gov.au\/en\/Legislation\/VOLATILE\u2010SUBSTANCE\u2010ABUSE\u2010PREVENTION\u2010ACT"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/j.1742-6723.2005.00774.x","article-title":"Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia","volume":"17","author":"Moshin M","year":"2005","journal-title":"Emerg. Med. Australas."},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.01.009"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.05.022"},{"key":"e_1_2_7_12_1","unstructured":"HenryB DunbarT BarclayL ThompsonR.Self\u2010Discharge Against Medical Advice from Northern Territory Hospitals. Prevalence Rates Experiences and Suggestions Economic Complications and Recommended Strategies for Improvement. 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