• Sandra J Brownlea, Justine Miller, Jessica Meagher, Federica Barzi, and Didier Palmer.
• Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
• Emerg Med Australas. 2019 Dec 1; 31 (6): 948954948-954.

ObjectiveDetermine clinical risk for patients presenting to Royal Darwin Hospital ED when they cannot be cared for at the police watch-house (WH) or sobering-up-shelter (SUS) because of a medical concern.MethodsThis is a retrospective cohort study of police arrivals from May to July 2016. Data collection included demographics and presumed cause of intoxication. Outcomes used as markers of risk were departure status, return visit within 24 h and frequency of ED attendance over 3 months. Social determinants of poor health were collected for the June cohort.ResultsThere were 247 attendances with police by 170 patients. Most were alcohol affected (monthly rates between 83% and 92%). The 'did not wait/left at own risk' rate was high (41-44% vs 7.7%; P < 0.001) and hospital admission rates low (2-7% vs 29%; P < 0.001). Rates of representation (20% within 24 h), ED attendance (≥73% had a further visit within 3 months), comorbidities (46% with three or more chronic diseases), homelessness (66%) and alcohol dependence (85%) were high. Patients presenting more than five times over 3 months were less likely to wait (odds ratio 2.4, 95% confidence interval 1.1-5.2, P = 0.03).ConclusionThis is a common presentation at Royal Darwin Hospital ED by a patient group with high levels of comorbidity, homelessness and alcohol dependence. Nearly half self-discharged prior to medical assessment. These patients frequently re-attend the same facilities and enter into a cycle of non-intervention. Case management across services is needed to improve the opportunity that these patients receive appropriate medical, social and addiction interventions.© 2019 Australasian College for Emergency Medicine.

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