Psychotic patient involved in stabbing transferred from emergency department

6:29 pm on 3 July 2020

A psychotic patient who was involved in a stabbing and assault at Middlemore Hospital may have been transferred from the emergency department to a general ward due to capacity and resource constraints, according to a report.

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Three members of staff at Middlemore Hospital were assaulted during the incident in May. Photo: LDR / Steven Forbes

The incident, which happened on 21 May, is outlined in a report to this month's Counties Manukau Health Hospital Advisory Committee meeting. It said the patient's transfer resulted in a stabbing incident and the physical assault of three members of staff.

Counties Manukau Health is currently conducting an internal review of the events that occurred.

The committee paper states: "Previous reports have raised and highlighted the risks to staff and other patients of the practice of referring behaviourally disturbed patients from emergency care to general medicine for non-medical reasons.

"General medicine is increasingly pressured to absorb these admissions to minimise the impact on patient flow and to mitigate capacity or resourcing constraints in other areas better equipped to appropriately care for these patients.

"These admissions have demonstrated that inappropriate placement into general medicine does not support the patient's best interests and on several occasions has caused harm. During May the admission of a psychotic patient to a general medical ward resulted in a stabbing incident and physical assault of three members of staff."

Last month Counties Manukau Health confirmed a staff member was attacked on 21 May. They said security was called and police attended the incident and a staff member was treated for their injuries.

It followed the release of a report by Counties Manukau Health which showed violent and aggressive behaviour towards nurses and other health workers remains an ongoing problem and remains in the top three of its health and safety incidents.

Sarah Dalton, the executive director of the Association of Salaried Medical Specialists, said the incident at Middlemore Hospital is an extreme event, but illustrates the pressures health providers face in dealing with mental health issues.

"If someone has an event and police are called they are more likely to be taken to an emergency department rather than the police cells these days," Dalton said. "But the bulk of our hospital emergency departments aren't an ideal place for someone having an acute mental health crisis, or for someone under the influence of drugs or alcohol.

"Ideally, mental health or behavioural admissions need different spaces that are quiet. And most of our hospitals are so far away from being able to provide that."

Patients end up in wrong place daily - nursing union

New Zealand Nurses Organisation (NZNO) professional nursing adviser Suzanne Rolls shared Dalton's concerns.

"Putting people into an environment that isn't suited should be avoided. But unfortunately it's a day-to-day occurrence."

She said many DHBs nowadays have staff on hand in their emergency departments to handle people with mental health issues. But she said the policy isn't applied consistently and there often isn't adequate funding.

A spokesperson for Counties Manukau Health said they couldn't comment on the incident in May as it is currently being investigated and it is awaiting the findings.

But a mental health assessment team is on hand at the Middlemore Hospital emergency department 24/7.

"Emergency physicians are trained to deal with acute behavioural disturbance. A number of service areas across the organisation are working collaboratively to ensure people who present with behavioural disturbances are cared for to the highest standards, whether they are due to underlying physical ill health, mental health or a combination of both."

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