Content
Background
Since the late 1990s a number of tools have been developed and refined to optimise consistency of triage for patients presenting to EDs with acute behavioural disturbance or primary mental illness. For example, in New South Wales, Sutherland Hospital developed mental health triage guidelines for EDs. 42 In Tasmania, Smart, Pollard and Walpole( 1999) 43 introduced a four-point mental health triage rating scale to be used in conjunction with the ATS. In Victoria, further evaluation of the Tasmania tool found differences in use according to specialist training, and suggested that further education was needed to improve the utilisation of the tool. 35 Later, the New South Wales Department of Health implemented guidelines for the management of mental health presentations to the ED. 36 South Eastern Sydney Area Health Services( SESAHS) went on to develop a five-point mental health triage tool to enhance consistency of triage in EDs for mental health presentations. 37 Referenced as best practice by the National Institute of Clinical Excellence, the SESAHS tool has been further refined by Broadbent et al. 47-49 and was recently implemented in all Victorian EDs. 41
Approach
There are two steps that are vital in determining time to treatment for people with mental health illness: obtaining accurate assessment data and applying an appropriate ATS code. These two steps should be conducted with an awareness of risk factors for harm( self-harm and harm to others). 43 In particular, high risk is attached to those with preexisting impairment from either severe or acute mental illness. 44
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Assessment
Patients may be brought to the ED by police, ambulance, community mental health workers or family members, as well as coming in by themselves.
The usual primary-survey approach to assessing all incoming patients should be completed prior to commencing a mental health assessment. This involves asking the patient why they are in the ED today, and who brought them. It is important to be open, listen for verbal cues, clarify, and not be judgemental. The assessment is not intended to make a diagnosis, but to determine urgency and identify immediate needs for treatment.
Psychotic illness, depressive illness, attempted suicide, suicidal thoughts, anxiety, acute situational crisis, substance-induced disorders, and physical symptoms in the absence of illness are the most common mental health presentations at triage.
Always maintain your safety and the safety of others. If a patient’ s behaviour escalates, withdraw and seek assistance immediately.
Department of Health and Ageing – Emergency Triage Education Kit