A 3-year experience of an Australian short-stay Psychiatric, Alcohol and Non-prescription Drug Assessment Unit: unit activity and the patient experience

Jane Ellen Carland; Yvonne Nguyen; Hannah Paul; Nadine Ezard; Matthew Bode; Bash Jagarlamudi; Mayura Sandrasegaran; Bridin Murnion; Richard Osborne Day; Paul Thomas Preisz; Jacqueline Huber; Jonathan Brett

doi:10.1136/emermed-2024-214653

A 3-year experience of an Australian short-stay Psychiatric, Alcohol and Non-prescription Drug Assessment Unit: unit activity and the patient experience

Emerg Med J. 2025 Dec 18;43(1):15-21. doi: 10.1136/emermed-2024-214653.

Authors

Jane Ellen Carland^{1

2}, Yvonne Nguyen³, Hannah Paul^{1

2}, Nadine Ezard^{4

5

6}, Matthew Bode⁷, Bash Jagarlamudi^{1

2

7}, Mayura Sandrasegaran⁴, Bridin Murnion^{1

2}, Richard Osborne Day^{1

2

8}, Paul Thomas Preisz⁷, Jacqueline Huber^{1

3}, Jonathan Brett^{9

2}

Affiliations

¹ School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia.
² Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.
³ Department of Mental Health, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁴ Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
⁵ National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, Sydney, New South Wales, Australia.
⁶ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
⁷ Department of Emergency Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁸ School of Biomedical Sciences, Faculty of Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia.
⁹ School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia j.brett@unsw.edu.au.

Abstract

Background: The Psychiatric, Alcohol and Non-Prescription Drug Assessment (PANDA) Unit was opened at St Vincent's Hospital Sydney in 2020 to provide short-stay medical monitoring and care for people presenting to the emergency department with alcohol or other drug intoxication or behavioural disturbance with co-existing general medical, drug and alcohol and/or mental health issues. The aim of this study was to describe the activity of the PANDA Unit across the first 3 years of operation and explore patient experience.

Methods: A mixed methods design was used. A retrospective record review (2020-2023) captured patient demographics, admission characteristics and discharge disposition. Brief, structured interviews were conducted with PANDA patients to explore their admission experience, including the care provided. Interviews were analysed using an inductive approach to develop themes.

Results: 2473 patients had 4108 admissions to PANDA, median 333 (range, 296-396) admissions per quarter. Median patient age was 40 (range, 16-93) years, most (64.5%) were male and 11.2% had 'no-fixed abode' documented. Most admissions were associated with alcohol and stimulant intoxication and/or suicidality. Median PANDA length of stay was 21.2 hours (range, 0.5-883.1); 20% of admissions were >48 hours. Most patients (83.8%) were discharged from PANDA to their usual place of residence, 4.9% self-discharged and 15% were readmitted to PANDA within 28 days of discharge, 56 people were readmitted three or more times. The experiences of interview participants (n=14) regarding the PANDA Unit was described by three key themes: (1) patients receive non-judgemental, whole-person care from a large multidisciplinary team, (2) PANDA provides a transition point to further care and (3) PANDA is a comfortable and busy space.

Conclusions: PANDA provided tailored care in a short-stay context for people presenting to emergency department with complex comorbidities. Its unique model of care addressed barriers to healthcare access, such as stigma and siloed care.

Keywords: emergency medicine; mental health; observational study; qualitative research; substance-related disorders.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Australia
Emergency Service, Hospital / organization & administration
Emergency Service, Hospital / statistics & numerical data
Female
Humans
Length of Stay / statistics & numerical data
Male
Mental Disorders* / therapy
Middle Aged
Retrospective Studies
Substance-Related Disorders* / diagnosis
Substance-Related Disorders* / therapy