Improving the Care of Mentally Ill Patients in a Tertiary Emergency Department: Development of a Psychiatric Assessment and Planning Unit

Objective: The aim was to describe the Psychiatric Assessment and Planning Unit (PAPU), established at the Royal Melbourne Hospital (RMH) to improve access to psychiatric care for patients presenting via the Emergency Department (ED). Method: PAPU was opened in January 2007. Data was recorded from RMH ED databases to compare ED lengths of stay (LOS) prior to and after establishing PAPU. Interventions including requirement for one-to-one nursing (i.e. one nurse dedicated to the care and observation of one patient) and mechanical restraint and unarmed security threats are routinely documented and were compared before and after PAPU opened. Demographic data and inpatient LOS information was collected by clinicians in PAPU. Results: During the 12 months of initial evaluation we found that PAPU assisted with reducing the number of patients waiting excessive LOS in the RMH ED essentially to zero, due to both expedient transfers from ED and increased direct admissions from the community. We were also able to demonstrate a reduction in mechanical restraint, security codes for unarmed threats and one-to-one nursing in the ED. Conclusions: The establishment of the PAPU at RMH has resulted in significant improvement in the care of patients with mental illness in the least restrictive environment, based on decreased LOS and need for interventions.