04 February 2020
News Category: 

A large number of threatening patients who presented at the Royal Melbourne Hospital (RMH) Emergency Department (ED) tested positive to methamphetamine use, according to new research.

Published in Emergency Medicine Australasia, University of Melbourne and Melbourne Health researchers examined data collected over a six-month period from point-of-care saliva tests from 229 valid samples.

Of the samples, 40 per cent tested positive, and of that number, 92 per cent tested positive for methamphetamines. 17 per cent of samples also tested positive for opiates, eight per cent for cannabis and seven per cent for cocaine.

The samples were taken from patients who required a security response for unarmed threat, using non-invasive point of care salivary testing; the first time this method has been used in this setting.

To place this in context, of the 80,000 admissions to the RMH annually, it could be that up to 3500 patients who present with acute behavioural disturbance such as aggression are on illicit substances when they come through, according to previous studies conducted in this field.

Melbourne Health Executive Director of Strategy, Quality and Improvement Professor George Braitberg said these numbers put a spotlight on a significant and growing cause of occupational violence in our hospitals and is a concern for the safety of our staff and patients.

“This is a growing problem and needs to be approached with a different model of care where emergency, mental health, addiction and allied health clinicians work together in the same space, to provide the best care for these patients,” Prof Braitberg said.

RMH Director of Emergency Research, Associate Professor Jonathan Knott said knowing information around the patients drug use was useful for staff to determine treatment strategies.

“These tests can demonstrate quickly and efficiently if there are drugs involved, if there are no drugs and the likely outcome is mental health then staff can work towards putting in place measures for providing the best care,” A/Prof Knott said.

The current development of a crisis hub based in the RMH ED will specialise in mental health, drug and alcohol support.

“With the introduction of the Behavioral Assessment Unit 3 years ago we do have resources to settle patients, however we don’t have strategies in place to help change behavior long-term. The crisis hub will create more resources to pathway patients to specialised help,” A/Prof Knott said.

“This study shows the size of the problem and provides us with new data to assist us in identifying patients more likely to display abnormal or behavioural disturbance and allow us to apply this knowledge in the design of our crisis hub to provide that different model of care,” Prof Braitberg said.

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