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Healthcare | Occupational Health & Safety

How to stop violence in hospitals

9 Nov 2021, by Amy Sarcevic

‘Prevention not cure’ has long been considered the Holy Grail of healthcare, but what if this same logic was applied to security in healthcare settings, in place of reactive strategies for combatting patient violence?

Associate Professor Paul Preisz who founded Australia’s first ever PANDA (Psychiatric, Alcohol and Non-Prescription Drug Assessment) unit believes preventing – not just diffusing – violence in hospitals is possible; and says tailored care for high-risk patients is the answer.

Since cutting the ribbon for his pioneering PANDA unit in Sydney last year, Preisz and his staff have virtually eliminated code blacks, despite treating upwards of 2000 psychiatric, alcohol, and drug-affected patients. This compares with an average of 10,000 code blacks every year in some traditional, metropolitan hospitals.

Preisz believes the logic behind this is simple: patients presenting with complex comorbidities behave differently when given the right care and environment.

“We came up with the idea of the PANDA unit when we realised that a lot of patients presenting to traditional emergency departments were falling through the cracks in the system. Many were too mentally distressed to be treated by regular healthcare physicians, yet too medically unwell to be transferred to psychiatric wards. This meant some were not getting their needs met – and becoming agitated as a result,” he said, ahead of the 2022 Safe & Secure Hospitals Conference.

“With psychiatric, drug and alcohol related symptoms making up a large portion of ED presentations, we wanted to create a place that would adequately cater to these complex needs. A place where patients with comorbidities could get a private bed away from the commotion of a typical ED, and receive urgent care from a specialised physician. Whilst it wasn’t what we set out to achieve, a key side-effect of this has been drastically reduced levels of patient violence.”

Within the dedicated, purpose-built unit, patients are treated for pain, infection, and withdrawal upfront – not left to sit for hours in a crowded waiting room, where agitation and interpersonal conflict often breeds.

“The PANDA unit offers a dignified and safe space where patients can draw on the expertise of Mental Health, Clinical Pharmacology and Alcohol & Drug teams. It’s a noticeably different atmosphere to traditional EDs which are often high-stimulation environments,” says Preisz.

“That’s because we aren’t under the same pressures as a typical ED, where many more people need to be assessed. We can treat patients there and then and keep them in for a 48 hour care cycle – a paradigm we have found appropriate for the bulk of patients we see.”

An added benefit of this model has been a downturn in ‘morbidity’ and ‘discharge against advice’ rates.

“In regular ED’s, 10-20 percent of psychiatric, drug and alcohol affected patients don’t complete their treatment, against the advice of physicians. Some suffer severe health outcomes or death as a result. In the PANDA unit, this is much less common,” said Preisz.

Foretelling its success, the $17.7 million six-bed PANDA unit was opened by Minister for Mental Health Bronnie Taylor in November last year. Funded by a $12 million grant from the NSW Government, the initiative has also received philanthropic support from SIRENS Group.

Preisz says that, alongside this support, a key part of the project’s success has been recruiting the right people.

“We reverse engineered the specialist to cater to the problem,” he said. “We have people with backgrounds in alcohol counselling, nutrition, and inpatient psychiatry; and have ended up with a fairly well rounded service. It’s a holistic pit-stop where people with complex comorbidities can get all of their needs addressed at once,” he said.

However, recruiting the right people has not been without challenges, given a national shortage of acute psychiatrists.

“It’s unusual to find psychiatrists that specialise in acute care. In fact, there are only a few dozen in Australia currently. We will gradually see this change though, as we are increasingly seeing mental health being managed in hospitals, particularly throughout COVID,” said Preisz.

The PANDA concept as a whole has also attracted interest throughout the pandemic, with other hospitals now looking to replicate the model. Paul believes (and hopes) this will be the start of a growing trend.

“We opened our doors in November and were immediately pretty full, which gives you some insight into the demand for services like this,” he said.

“We are pleased with our progress so far. Having the right mental health protocols and environment doesn’t just stop with work health and safety. It creates better health outcomes for patients – both with complex comorbidities and those who may otherwise be exposed to violence.”

The Safe & Secure Hospitals Conference is now scheduled for 2022. Register your interest to receive a program upon completion.

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