Objective: Determine clinical risk for patients presenting to Royal Darwin Hospital ED when they cannot be cared for at the police watchhouse (WH) or sobering-up-shelter (SUS) because of a medical concern. Methods: 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 h and frequency of ED attendance over 3 months. Social determinants of poor health were collected for the June cohort. Results: There were 247 attendances with police by 170 patients. Most were alcohol affected (monthly rates between 83% and 92%). The 'did not wait/left at own risk' rate was high (41-44% vs 7.7%; P < 0.001) and hospital admission rates low (2-7% vs 29%; P < 0.001). Rates of representation (20% within 24 h), ED attendance (≥73% 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 months were less likely to wait (odds ratio 2.4, 95% confidence interval 1.1-5.2, P = 0.03). Conclusion: 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-discharged prior to medical assessment. These patients frequently re-attend the same facilities and enter into a cycle of non-intervention. Case management across services is needed to improve the opportunity that these patients receive appropriate medical, social and addiction interventions.

Objective Assess the impact of Northern Territory alcohol policy changes to ED utilisation at Royal Darwin‐Palmerston Regional Hospitals. Methods Interrupted time series analysis explored trends in monthly ED attendance numbers and the proportion self‐discharging prior to policy changes (September 2016 to August 2017) and after three sequential interventions; the Banned Drinker Register, introduced September 2017, system changes to the sobering shelter, January 2018, and the minimum unit floor price (MUFP), October 2018. A targeted cohort of attendances transported by police as an alternative to the sobering shelter or police watch‐house when there is a medical concern was selected as they are likely impacted by all policy changes. Results Police transported 1176 patients on 2070 occasions from September 2016 to March 2019. There was a downward trend in monthly attendances across the study period, with no significant change attributable to the Banned Drinker Register, a significant step decrease with the sobering shelter changes (P = 0.002), and a significant gradual decrease following the MUFP (P = 0.025). This represented an immediate decrease of 3.82 attendances per month/10 000 residents following the sobering shelter changes and a gradual decrease of 0.92 attendances/10 000 residents after the MUFP. Rates of self‐discharge were high, 45% in the pre‐intervention phase, decreasing to 28% following the MUFP but this trend did not reach significance with any intervention. Conclusion The sequential introduction of broad sweeping alcohol policy changes introduced by the Northern Territory government was associated with significant reductions in ED utilisation. The proximity of the introduction of interventions creates difficulties identifying individual policy influence.