Euan Donley
1/ Eastern Health Psychiatric & Emergency Dept Response Team
2/ Monash University PhD Candidate
Emergency Departments (EDs) are heavily burdened as presentation rates continue to rise. To improve patient flow National Emergency Access Targets (NEAT) were introduced. NEAT implements timelines for ED presentations, such as discharging patients within four hours of arrival. Mental health patients use EDs more than the general population and are generally more complex in their presentations.
The aim of this study was to examine the impact of NEAT on psychiatric risk assessment of mental health patients in the ED. Seventy six mental health clinicians from 7 EDs in Victoria, Australia participated in a mixed method analysis via anonymous online survey.
NEAT was considered helpful as mental health patients were seen quicker, were less likely to abscond, could improve teamwork amongst ED staff, and in some cases administrative processes were better streamlined. However, clinicians felt that NEAT was also responsible for less time with patients and relatives’, resulted in rushed assessments, unsafe practice, placed further pressure on mental health clinicians, and not conducive to training.
The profile of a patient typically likely to be treated within NEAT timelines showed a perfect storm of luck and compliance. If a patient was not intoxicated, was medically stable, referred early, did not require much collateral information and did not have distressed relatives, NEAT was more likely to be met. Limited mental health staffing, multiple ED presentations and a shortage of mental health beds also hamper meeting NEAT.
Findings suggest there are some advantages to NEAT, however, demanding caseloads promoted potentially dangerous short cuts in ED psychiatric assessment.
The full publication can be viewed via two articles online;
1/ Impact of National Emergency Access targets (NEAT) on Psychiatric Assessment in Hospital Emergency Departments, (2016) International Journal of Emergency Mental Health
2/ National Emergency Access Targets and Psychiatric Risk Assessment in Emergency Departments: Implications for Involving Family or Carers, (2016), Journal of Psychiatry and Mental health.
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EUAN DONLEY
Psychiatric and Emergency Dept Response, Eastern Health PhD Candidate, Monash University
Ph: 1300 721 927