Substance misuse and the involuntarily presentation to the Emergency Department

James Hughes1, Maureen Sheehan2, Jill Evans3

1Princess Alexandra Hospital, Brisbane, Australia, 2Drug and Alcohol Brief Intervention Team, Logan Hospital, Medowbrook, Australia, 3Metro South Addiction and Mental Health Services, Brisbane, Australia

Background: Alcohol and other drug (AOD) use are common in our society. The use of these substances flow throughout all areas of healthcare and is especially prevalent in patients presenting to the emergency department with signs of mental illness. At the extreme end of these presentations, patients present involuntarily with either police or ambulance officers via an Emergency Examination Order (EEO).

Aim: The aim of this study was to identify and describe the population presenting to the ED involuntarily with and without substance misuse as a precipitating factor and explain the differences in care between these two populations.

Methods: Quantitative descriptive analysis was used to describe this population between April and June 2015.

Results:  During the study period, there were 317 patients reported to be on an EEO presented, which represented 2.32% of total presentations for this time. In patients presenting to one large inner city emergency department involuntarily, 30% had alcohol or other drug misuse as a precipitating factor. Patients who involuntarily presented with alcohol and other misuse stay longer in the emergency department than others that do not have alcohol or other drug misuse. These patients frequently represent, with over 50% representing at 90 days however this was not associated with alcohol or other drug misuse. Almost all patients who present involuntarily are discharged home post review by a mental health team. Significant improvements in care can be made in this population if the opportunistic treatment of both mental illness and AOD misuse is completed in the emergency department.


Mr Hughes has worked in some of the busiest emergency departments in Queensland. He currently is a Clinical Nurse Consultant at the Princess Alexandra Hospital in Brisbane and is completing his PhD in factors that influence pain care in the emergency department.