Impact of acutely behavioural disturbed patients in the emergency department: A prospective observational study

Abstract

Patients with acute behavioural disturbance often have a history of mental illnesses and are commonly intoxicated. These patients have impacts on healthcare resources and pose risks to staff safety, but significant complications to patients do not occur frequently.

Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17

“…[35][36][37][38] In Australia, increased hospital admissions due to the misuse of cannabis, amphetamine and opioids between 1993 and 2012 have been previously identified. 39 Importantly, as presentations due to psychoactive substance use are associated with acute behavioural disturbance, and thus resourcing and safety implications, 40 the increase in these presentations represents a significant increasing burden for EDs.…”

Patient and clinician experiences with an emergency department‐based mental health liaison nurse service in a metropolitan setting

“…In addition to environmental factors, it has been reported internationally that individuals who access the ED for mental health care feel stigmatized by ED staff, leading to feelings of shame, invalidation, and abandonment (Carstensen et al 2017; Clarke et al 2007; Harris et al 2016; Vandyk et al 2018; Wise‐Harris et al 2017). Yet, there are many challenges for ED staff in supporting individuals experiencing mental distress, including optimizing timely access to appropriate care; responding to acute behavioural problems in a busy clinical environment (Oliver et al 2019); limited physical space to work within; insufficient mental health resources; time pressures associated with meeting key performance indicators (Innes et al 2013; Weiland et al 2011) and ensuring staff have the knowledge, skills, confidence, and resources to work effectively in this context.…”

Variations in the care of agitated patients in Australia and New Zealand ambulance services

“…Half of the services had specific guidelines for the management of violent psychostimulant patients although the management strategies differed and essentially reflected the services' guidelines for managing severely agitated patients. In Australasia, one of the most common psychostimulants associated with agitation and violence in acute care services is crystal methamphetamine . Methamphetamine‐related psychosis represented 93% of all stimulant‐related psychosis attended by AV, and patients were largely young males in metropolitan areas who required police co‐attendance because of the risk of violence .…”

“…Acute agitation is characterised as high anxiety, restlessness and aggression, and can result in delirium, cardiac arrest and death . Undifferentiated agitation may be because of alcohol or drug intoxication, psychiatric illness or underlying medical conditions . In medical emergencies involving aggressive patients, paramedics and police are often the first responders, although the prevalence of acute agitation in the pre‐hospital setting is unknown.…”