Volume 63, July 2022, 101188AbstractBackground

People brought in by police (BIBP) to the emergency department (ED) can present with complicated health conditions that may impact care delivery. We sought to identify factors predictive of an ED length of stay (LOS) ≥4 hours and hospital admission for presentations BIBP.

Methods

This retrospective cohort study comprised a sample of all adults (aged ≥ 18 years old) BIBP to public hospital EDs across Queensland, Australia between 1 January 2018 and 31 December 2020. Univariate and multivariate logistic regression were used to identify predictors of an ED LOS ≥4 hours and hospital admission for presentations BIBP.

Results

Of the 42,502 presentations BIBP, independent predictors of an ED LOS ≥4 hours included higher priority triage categories, hospital transfer/admission, evening/night shift arrival, an Emergency Examination Authority (EEA), (i.e. an involuntary presentation), and a non-descript mental health diagnosis. Independent predictors of hospital admission included higher priority triage categories, increasing age, day/evening shift arrival, a ‘mental or behavioural issues’ diagnosis, and an ED LOS ≥4 hours.

Conclusions

Noted predictors of a LOS ≥4 hours and hospital admission indicate further need to support intra and inter-agency interventions to optimise patient outcomes.

Section snippetsBackground

Timely and effective health care delivery in the emergency department (ED) is essential to address the increasing presentations occurring in EDs worldwide. However, ED health care delivery may be hindered by many elements such as presentation numbers, care requirements, staffing, resource allocation, and crowding [1]. A longer ED length of stay (LOS) is associated with a number of factors such as age, clinical acuity, and mode of arrival by police [2]. In the United States (US), a North

Study design and setting

This was a retrospective cohort study set in Queensland, Australia. Queensland had a population of approximately 5 million in 2020 [13]. In 2019–20 inclusive, 1.6 million patient presentations were made to Queensland public hospital EDs [3] and of these, 0.87% (n = 13,920) were BIBP.

Sample

The population included all presentations made to Queensland public hospital EDs between 1 January 2018 and 31 December 2020. The sample included all adult (aged ≥18 years old) ED presentations during the same time

Results

A total of 4,707,959 presentations aged ≥18 years were made to Queensland public hospital EDs over the 3-year period; of these, 42,502 (0.9%) were BIBP. The demographic and clinical profile of all presentations BIBP and those based on ED LOS ≥ 4 hours and hospital admission status are presented in Table 2. In total, 79% of ED presentations BIBP were <45 years of age (n = 33,639), with 67% being male (n = 28,493). An Indigenous status accounted for 22% of all presentations BIBP (n = 9,200), with

Discussion

This study identified several factors predictive of an ED LOS ≥ 4 hours and hospital admission for patient presentations BIBP. This finding adds to previous literature that has highlighted the existence of clinical and demographic differences between people BIBP and not BIBP [9], [10], but not necessarily the strength of the difference. These and other findings [8] support the need to further understand and develop specialised care pathways for people BIBP. Predictors identified in this study

Limitations

This study has several limitations. As it is retrospective in nature, causation cannot be determined, only association. Additionally, generalisability may be limited as the sample included only Queensland facilities that report to the EDC, with type of facility and where people BIBP came from (custody/community setting) not available. There may have been inaccuracies within the data provided, but measures were taken to clean data through completeness assessments. For the present study, only

Conclusion

Patient presentations to the ED with police have unique clinical characteristics that influences their ED LOS and hospital admission. Our results highlight the relationship between various factors including mental health, a long ED LOS and hospital admission. With 35% of presentations BIBP remaining in ED longer than four hours and 34% requiring hospital admission, resourcing implications for police, nursing staff and EDs warrant investigation. Future research may contribute to the development

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgment

The authors thank Professor Robert Ware for providing statistical advice towards the present study.

Ethical statement

Ethical approval was granted by the Health Service (HREC/2020/QGC/62686) and Griffith University (2020/602) Human Research Ethics Committees. As this study uses de-identified retrospective patient data, state Public Health Act approval (PHA 62686) was required and granted.

Funding source

None.

Data sharing and data accessibility

We are unable to share or make publicly available data used for the present study due to ethical approval and data privacy requirements.

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