title: Retrospective case note review of patients brought to Ipswich emergency department under mental health emergency examination orders: does intoxication alter outcome?
abstract: OBJECTIVE
  To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients.
  
  
  METHODS
  Consultation-Liaison mental health nursing staff completed surveys on all patients assessed under emergency examination orders over a 6 month period in 2008. Patients were classified as intoxicated if they recorded alcometer readings of greater than 0.05%, or self-reported drug use during the events leading to their transport to the ED. Outcomes were retrospectively collated with entries in Clinical Liaison nursing logbooks. Outcome measures recorded were rates of admission, outpatient referrals to the Integrated Mental Health Service, follow up by other community services or no follow up. Differences in outcomes for intoxicated and non-intoxicated patient groups were tested for significance using χ(2) or Fisher's exact test.
  
  
  RESULTS
  One hundred and sixty-eight cases were included in the audit. No cases were excluded. Sixty patients were identified as intoxicated. The age and sex distributions were similar between intoxicated and non-intoxicated patients. There were no significant differences in admission or referral rates. The average length of assessment time in the ED was longer in the intoxicated group.
  
  
  CONCLUSIONS
  This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.
authors.affiliation: Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland 4305, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brierley
authors.forename: Kylie
authors.initials: K
authors.lastname: Baker
authors.forename: Janet
authors.initials: J
authors.lastname: Brack
authors.forename: Peter
authors.initials: P
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D001315:Australia; D003156:Community Mental Health Services; D003419:Crisis Intervention; D019033:Delivery of Health Care, Integrated; D004637:Emergency Services, Psychiatric; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D055815:Young Adult