ACEM Annual Scientific Meeting Best Trainee Paper, Port Douglas 2011
Involuntary psychiatric admissions under the Mental Health Act 2007 (NSW): A comparative study of patients who were detained by ambulance officers and medical officers and accredited persons within a NSW Hospital Emergency Department.
Authors: Dawn Cutler, Mechelle Smith, Timothy Wand, Tim Green, Michael Dinh and Robert Gribble. Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Introduction: The Mental Health Act 2007 (NSW) (MHA) is used to transport to, detain and treat individuals in a mental health facility. Patients are frequently taken to Emergency Departments (ED) under the MHA or detained in the ED for a mental health assessment. In NSW, medical practitioners, accredited persons, police, and more recently ambulance officers, are authorised to write certificates under the MHA. There is an absence of research on the use of the MHA in NSW EDs. The primary research question for this study was: „What is the involuntary admission rate for persons detained under the MHA in a NSW tertiary referral ED?‟
Methods: After gaining ethics approval, the research team prospectively collected the MHA certificates written for patients in the ED over a three month period from February to May 2011. The research team reviewed the MHA certificate and medical records to characterise demographics, outcome, length of stay in ED and certificate suitability. Outcomes were then compared between the different professional groups completing the certificate.
Results: The involuntary admission rate for patients certified by ambulance officers under the NSW MHA was 27 per cent, compared with a 60 per cent involuntary admission rate when certified by medical officers or accredited persons. The mean average length of stay in the ED for patients certified under the MHA was 10 hours. 75 per cent of patients were presented out of hours.
Conclusion: Ambulance officer certification was a poor predictor of involuntary psychiatric admission in the Royal Prince Alfred Emergency Department. Emergency Department physicians should have the authority to revoke the certificate if, following assessment and treatment, the patient no longer fulfils criteria for detention under the MHA.
"Take Home Tips from SSEM"
My take home tip would be: "Don't be prescriptive! Engage clinicians in identifying the communication problems and developing solutions to those problems."
To view Sarah Whites presentation at the 2011 SSEM gathering please click here
Thank you for your contribution Sarah!
My take home tip :- Every DEM / Casualty Dept. should have an iCare tonometer, intraocular pressures should then be done on every patient with who presents with an eye complaint. These tonometers are accurate, very easy to use with minimal training, no drops are required and can be used on kids and adults.
My take-home tip is: "When someone is dying, one organ system has to fail first. It's not necessarily kind to the patient to treat just that system and prolong the dying process."
Take home tips from "Journal Club... What is New and Important?"
Tranexamic Acid in Trauma- The CRASH 2 Trial:
Large well done RCT showed a 1.5% absolute mortality reduction when given to sick bleeding trauma patients within 8 hours. The biggest issue with the
study was external validity. Most patients enrolled were from developing countries and 1/3 had penetrating trauma. Nevertheless, our audience took a less cynical view of this study. Tranexamic acid is cheap,
probably won't hurt and likely will have some minor benefit. Certainly our practice has changed in EM based on less rigorous data (i.e. thrombolysis of stroke). Subgroup analysis showed it is most beneficial if given within 3 hours. The jury is still out in modern health care environments but another study of similar quality is thought to be unlikely.
Dabigatran vs. Warfarin in Patients with Atrial Fibrillation.
This study was the phase III trail by Boehringer Ingelheim that got TGA approval for this drug. Dabigatran was marginally better than warfarin (by 0.16%) at preventing stroke with similar bleeding risk. It is not yet PBS listed and will cost about $3000/year. There is currently no reversal agent for dabigatran and experience with bleeding issues should become apparent in the next few years. There are a number of other anticoagulants being developed. The anticoagulants are going to explode on the market (when PBS listed) as they will be heavily promoted by the pharmaceutical industry... Will there come a day when we say, "Remember when we used to give patients warfarin?"
New High Sensitive Troponin Assays (Keller NEJM 27 August 2009).
The general consensus from the audience was that the new troponin assays have created a lot of headaches. We have lost a lot of specificity at the expense of gaining sensitivity. Some participants wished we could go back to the old assay.
Queensland Autumn Symposium
"Trainee Prize Goes South From Queensland Meeting"
ASEM again has been proud to be able to partner the college at the Autumn Symposium 2011 of the Queensland Faculty of ACEM and be able to present the prize for the best trainee presentation.
As in previous years this meeting attracted emergency medicine clinical staff from both within Queensland and from the other states and NZ as well. The meeting over two days covered a range of plenary and workshop based programs. Of major interest to the gathered EM staff was the debate on “My Ramping Rules” which covered a variety of views of how metropolitan, non-metropolitan departments cope with this ever increasing issue.
Also on the panel were the Queensland Ambulance Service as well a senior member of Queensland Health executive. The panel certainly engaged in a most vigorous discussion but I am not sure if any solutions were concluded. The workshops covered a variety of topics including an ultrasound workshop, dental emergency workshop, a nursing workshop and a fellowship exam preparation workshop.
There was a significant political acknowledgement of the importance of this meeting with the new Queensland Minister of Health attending to present the latest round of research grant awards from the Queensland Emergency Medicine Research Foundation.
There were eight trainee presentations this year and the trainee prize this year went to a Monash Medical Centre – Clayton trainee. Christopher Groombridge’s paper on: "Comparison of central venous pressure and venous oxygen saturation from venous catheters placed in either the superior vena cava or via a femoral vein, in an adult intensive care population: The numbers are not interchangeable" was a unanimous choice of the judges who were very impressed with the high standard of Christopher’s paper. Christopher’s prize was an award of $250 in addition to a complimentary membership of ASEM for the 11/12 financial year.