Effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department

Abstract

Objective People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. This study evaluated the effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department (ED). Methods This was a retrospective observational study conducted in a regional ED in Queensland. Equal time periods of 66 days before (T1), during (T2) and after (T3) the pilot service was trialled in 2013 were compared to determine changes in patient and service delivery outcomes. The time to see a doctor in the ED, ED length of stay, hospital admission rate, number of transfers from the watch house to the ED and associated costs were measured. The nature of health care delivered by nurses to detainees in the watch house during the pilot was also examined. Results Fewer detainees were transferred from the police watch house to the ED during the pilot period (T1, n=40; T2, n=29; T3, n=34). Cost reductions associated with reduced police and ambulance attendance, as well as hospitalisations, outweighed the watch house nursing costs, with cost savings estimated at AUD7800 per week (60% benefiting police; 40% benefiting the health service). The most common health problems addressed during the 1313 healthcare delivery episodes provided to 351 detainees in the watch house during the pilot related to substance misuse, chronic disease and mental health problems. Conclusion Fewer transfers from the police watch house to the ED were noted when there was a 24/7 nursing presence in the watch house. This model appears to be economically efficient, but further research is required. What is known about the topic? People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. What does this paper add? Transfers from the police watch house to the ED were fewer when there was a 24/7 nursing presence in the police watch house (an economically efficient model). Nursing care provided to detainees in the watch house setting predominantly related to substance misuse, chronic disease and mental health problems. What are the implications for practitioners? With a 24/7 nursing presence in the police watch house, transfer to the ED was avoided for some detainees. Similar strategies that respond to coronial recommendations advocating for enhancements in police-health collaboration warrant evaluation.