Supporting equitable care of patients transferred from police watch-houses to the emergency department: A qualitative study of the perspectives of emergency doctors

Caitlin Brandenburg; Stuart Dm Thomas; Cathy Lincoln; Annabel Somerville; Ed Heffernan; Stuart A Kinner; Joshua Byrnes; Paul Gardiner; Peter Davidson; Nathan Daley; David Green; Julia Crilly

doi:10.1111/1742-6723.14408

Supporting equitable care of patients transferred from police watch-houses to the emergency department: A qualitative study of the perspectives of emergency doctors

Emerg Med Australas. 2024 Apr 22. doi: 10.1111/1742-6723.14408. Online ahead of print.

Authors

Caitlin Brandenburg^{1

2}, Stuart Dm Thomas³, Cathy Lincoln⁴, Annabel Somerville^{4

5}, Ed Heffernan^{6

7

8}, Stuart A Kinner^{9

10

11

12}, Joshua Byrnes¹³, Paul Gardiner¹⁴, Peter Davidson¹⁵, Nathan Daley¹⁶, David Green¹, Julia Crilly^{1

2

17

18}

Affiliations

¹ Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
² Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
³ Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia.
⁴ Forensic Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
⁵ Department of Emergency Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.
⁶ Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
⁷ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁸ Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Queensland, Australia.
⁹ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Justice Health Group, Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹¹ Justice Health Group, Curtin University, Perth, Western Australia, Australia.
¹² Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia.
¹³ Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia.
¹⁴ Cairns Watch-House, Far North District, Queensland Police Service, Cairns, Queensland, Australia.
¹⁵ Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego, California, USA.
¹⁶ Queensland Ambulance Service, Brisbane, Queensland, Australia.
¹⁷ School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
¹⁸ Centre for Mental Health, Griffith University, Gold Coast, Queensland, Australia.

PMID: 38650377
DOI: 10.1111/1742-6723.14408

Abstract

Objective: People detained in short-term police custody often have complex health conditions that may necessitate emergency care, yet little is known about their management in EDs. The present study aimed to understand ED doctors' experiences and perceptions regarding the appropriateness and management of detainee transfers from police watch-houses to the EDs.

Methods: A qualitative descriptive study, using semi-structured interviews undertaken with ED doctors working in five purposively sampled EDs across Queensland, Australia. Data were analysed using inductive content analysis.

Results: Fifteen ED specialists and trainees participated. Participants reported that their overarching approach was to provide equitable care for watch-house detainees, as they would for any patient. This equitable approach needed to be responsive to complicating factors common to this population, including presence of police guards; restraints; complexity (physical/mental/social) of presentation; reliance on police to transport; ED doctors' often limited understanding of the watch-house environment; justice processes and uncertain legal disposition; communication with the watch-house; and detainees misreporting symptoms. Thresholds for assessment and treatment of detainees were contextualised to the needs of the patient, ED environment, and imperatives of other relevant agencies (e.g. police). Participants often relied on existing strategies to deliver quality care despite challenges, but also identified a need for additional strategies, including education for ED staff; improved communication with watch-houses; standardised paperwork; extended models of watch-house healthcare; and integrated medical records.

Conclusions: Providing equitable healthcare to patients transported from watch-houses to the EDs is challenging but essential. Numerous opportunities exist to enhance the delivery of optimal care for this underserved population.

Keywords: custody; emergency department; equity; police; qualitative.

Grants and funding

EMLE-142R33-2020/Emergency Medicine Foundation