title: 'Nurse specialling': Direct nursing observation in the emergency department compared to other wards of an urban teaching hospital in Sydney.
abstract: OBJECTIVE
  This study examined the patterns of direct observation of patients by nursing staff ('nurse specials') and compared those required for mental health/drug health (MH/DH)-related presentations to other patient groups in different care settings.
  
  
  METHODS
  A retrospective review of nurse special shifts requested during the 2014 calendar year at an urban teaching hospital.
  
  
  RESULTS
  Hospital-wide 14,021 8-hour nursing shifts were ordered for special observation of patients, an average of 39 per day. Of these, 30% were requested for MH/DH-related presentations, with the majority (70%) required for medically unstable patients. However, of the 1917 shifts required in the emergency department, 1841 (96%) were for MH/DH presentations compared to 76 (4%) for patients with unrelated medical conditions (odds ratio 98.2; 95% confidence interval 77.71-124.06, P<0.0001).
  
  
  CONCLUSIONS
  In contrast to the rest of the hospital, emergency department-based nurse special requests were significantly more likely to be for MH/DH presentations. This figure represents a considerable staff and financial burden and may be reduced by diversion or more rapid transfer of such presentations to an appropriate inpatient ward.
authors.affiliation: Medical Student, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Maryssa
authors.initials: M
authors.lastname: Portelli
authors.affiliation: Postdoctoral Research Associate, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Bethany
authors.initials: B
authors.lastname: White
authors.affiliation: Associate Professor, Sydney Nursing School, The University of Sydney, Sydney, NSW, and; Nurse Practitioner, Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wand
authors.affiliation: Clinical Director, Drug Health Services, Sydney Local Health District, Camperdown, NSW, and; Professor and Head, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.affiliation: Professor of Psychological Medicine, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Glozier
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009517:New South Wales; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: comorbidity; direct observation; drug health; emergency department; medical instability; mental health; nurse special