SAFETY
How this hospital halved its
code blacks Amy Sarcevic
I
t used to be a familiar scene for Emergency Department Director Prof. Paul Preisz. A psychiatric or drug-affected patient being ferried to and from departments. Too behaviour-disturbed to be treated by medics. Too physically unwell to be in the sole care of psychiatrists. Often left to sit for hours in a crowded waiting room, or in the back of a police wagon, the patient’s condition would worsen, agitation would breed and violence would typically ensue. In fact, scenarios like this are said to account for a large portion of Australia’s hospital violence statistics. In some metropolitan hospitals, up to 10,000 code blacks are reported every year; and across the sector, up to 38% of workers have experienced physical assault at least once in their careers. Witnessing too many patients with comorbidities falling through the cracks in the system, Prof. Preisz founded Australia’s first ever PANDA (Psychiatric, Alcohol and Non-prescription Drug Assessment) unit at St. Vincent’s Hospital in November 2020 — a holistic pit stop where people could have their complex needs addressed at once. Never turned away, patients presenting at the PANDA unit are immediately granted a quiet personal space where a team of toxicologists, psychiatrists, doctors and other specialists provide a unique blend of acute and social care. The result: a 50% reduction in ‘code blacks’ since the unit’s inception, amongst a cohort that would typically present the highest risk group for security threats. Today, Prof. Preisz — whose unit has treated upwards of 3000 people to date — spends more of his time poring over thank you cards from patients, than security incidents from staff. “The reduction in patient violence is quite a remarkable side effect of the PANDA initiative,” he told Hospital + Healthcare. “With our main goal to adequately treat 16
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complex comorbidities, it wasn’t what we set out to achieve. However, given the current rates of violence among this patient cohort, it is certainly something to be celebrated.” In fact, Preisz recalls receiving a heartfelt thank you note from one of his most challenging patients. Recently out of jail, the man was homeless, had a significant drug history and was experiencing methamphetamine-induced psychosis when he presented at the PANDA unit. In a traditional healthcare setting, he would likely have become aggressive or violent. At PANDA, he remained cooperative and amenable to treatment. AUTUMN 2022
“The man was immediately given a private bed away from the commotion of the emergency department, where staff were able to diffuse his temperament and provide tailored care. Shortly after admitting him, we placed him on a fairly strong detox program and provided the necessary social supports. It turned out the patient had a significant background of post-traumatic stress disorder and a range of medical issues, including high blood lipids and prediabetes. We arranged housing for him and enrolled him as an outpatient to provide longer-term medical care,” Preisz said. Not long after his admission, Preisz and team were surprised to receive the man’s
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